Nephrotic / Nephritic Syndromes

Question 1

Signs of nephrotic syndrome

Answer 1

Proteinuria
Oedema
Hypoalbuminaemia

Question 2

At the level of glomerulus, the pathogenesis of nephrotic syndrome is

Answer 2

Increased glomerular capillary permeability (to allow proteins but not whole RBCs as in nephritic syndrome)

Due to damage to podocytes

Question 3

Primary causes of nephrotic syndrome

Answer 3

• Minimal change disease (most common form in children)
• Focal segmental glomerulosclerosis
• Membranous glomerulonephritis
• Mesangial proliferative glomerulonephritis (inflammation and antibody deposition)
• Rapidly progressive glomerulonephritis (cresent moon glomeruli, involves rapid decrease of up to 50% of GFR, within days to a few months)

Question 4

Secondary causes of nephrotic syndrome

12

Answer 4

• Diabetic nephropathy –> chronically elevated sugars leads to damage
• SLE –> immunocomplex deposition causes damage
• Sjogren’s Disease –> as for SLE
• Sarcoidosis –> rarely causes this, but can if enough granulomas in glomeruli
• Syphillis –> secondary syphillis
• Hep B –> antigen accumulation causes damage
• Amyloidosis –> Amyloid substance deposition causes damage
• Multiple myeloma –> cancer cells reach kidneys, causing local damage
• Vasculitis –> via inflammation of glomeruli vessels
• HIV –> virus antigens cause obstruction in glomeruli capillaries
• *Drugs –> local reaction
• *Congenital –> Congenital nephrotic syndrome –> ‘nephrin’ protein is altered

Question 5

Signs of nephritic syndrome

Answer 5

Haematuria
HTN
Oliguria
Uremia
(also proteinuria and associated things)

Question 6

Pathogenesis underlying nephritic syndrome

Answer 6

Damage –> thin basement membrane and large pores in podocytes of glomeruli
Large enough to allow passage of RBCs
(thus, RBC casts are a major indicator of bleeding of nephritic origin)

Question 7

Classic causes of nephritic syndrom

Answer 7

• Post-strep glomerulonephritis

- Rapidly progressive glomerulinephritis (rapid reduction in GFR of up to 50% within days to a few months)

Question 8

Causes of Nephritic syndrome - Focal and proliferative

Answer 8

• IgA Nephropathy
• SLE
• Alport syndrome
• Hepatorenal syndrome in chronic liver failure