Nephrotic syndrome

Question 1

Define nephrotic syndrome

Answer 1

Characterised by a triad of:
Proteinuria (> 3g/24hr)
Hypoalbuminaemia (< 30 g/L)
Oedema

(Hypercholesterolaemia is also a common feature)

Question 2

Aetiology of nephrotic syndrome

2 causes + 7 more

Answer 2

Most common cause - minimal change glomerulonephritis in children

ALL forms of glomerulonephritis can cause nephrotic syndrome

Other causes -
Diabetes mellitus
Sickle cell disease
Amyloidosis
Malignancies (lung & GI adenocarcinoma)
Drugs (e.g. NSAIDs)
Alport’s syndrome
HIV

Question 3

Epidemiology of nephrotic syndrome

children, adults x2

Answer 3

90% of nephrotic syndrome in children due to minimal change glomerulonephritis

Most common cause in adults
Diabetes mellitus
Membranous glomerulonephritis

Question 4

Presenting symptoms of nephrotic syndrome

5

Answer 4

FH of atopy (in those w/ minimal change glomerulonephritis)
FH of renal disease
Swelling of face, abdomen, limbs, genitalia
Symptoms of underlying cause (e.g. SLE)
Symptoms of complications

Question 5

Signs of nephrotic syndrome on physical examination

3 + 2

Answer 5

Oedema -
Periorbital
Peripheral
Genital

Ascites -
Fluid thrill
Shifting dullness

Question 6

Investigations for nephrotic syndrome

6

Answer 6

Bloods
Tests to identify cause
Urine
Renal US
Renal biopsy
Other imaging

Question 7

Investigations for nephrotic syndrome - bloods

8

Answer 7

FBC
U&Es
LFTs - low albumin 
ESR/CRP
Glucose
Lipid profile (check for secondary hyperlipidaemia)
Immunoglobulins
Complement

Question 8

Investigations for nephrotic syndrome - tests to identify cause
(4)

Answer 8

SLE - ANA, anti-dsDNA antibodies
Infections - group A β-haemolytic streptococcal infection (ASO titre), HBV infection (serology), Plasmodium malariae (blood film)
Goodpasture’s syndrome - anti-glomerular basement antibodies
Vasculitides - polyangitis w/ granulomatosis, microscopic polyarteritis (check ANCA)

Question 9

Investigations for nephrotic syndrome - urine

3

Answer 9

Urinalysis (check protein & blood)
MC&S
24hr collection (calculate creatinine clearance & 24hr protein excretion)

Question 10

Investigations for nephrotic syndrome - renal US

Answer 10

Exclude other causes e.g. reflux nephropathy

Question 11

Investigations for nephrotic syndrome - other imaging

3

Answer 11

Doppler US
Renal angiogram
CT/MRI (if renal vein thrombosis suspected)