Nephrotic Syndrome Flashcards
What are the key presentations for nephrotic syndrome?
Proteinuria, hypercholesterolaemia, hypoalbuminaemia
How does proteinuria present?
Frothy urine, infection
How much protein is there in the urine?
> 3,5g per 24 hours
How does hypercholesterolaemia present?
Xanthelasma, xanthomata, atherosclerosis
How does hypoalbuminaemia present?
Oedema, fatigue, dyspnoea, leukonychia
What are the steps in nephrotic syndrome pathology?
Inflammation –> damage to podocytes –> increased liver activity –> reduced oncotic pressure
What causes inflammation?
Immune cells, complement, HTN, atherosclerosis, medications/immunisations, infection
What does podocyte damage lead to?
Protein leakage
Why does liver activity increase?
To increase albumin
What happens due to increased liver activity?
Cholesterol and coagulation factors increase
What happens due to reduced oncotic pressure?
Oedema, blood volume decrease, RAAS stimulation, exacerbation
What blood tests would you do?
U&E, FBC, LFT, CRP, Calcium, glucose
What urine tests would you do?
MSU, dipstick
What imaging would you do?
USS of kidney, CXR
What would you screen for?
HIV, HBV, HCV
What is the gold standard investigation?
Needle biopsy and microscopy
How do you manage nephrotic syndrome generally?
12 weeks corticosteroids - prednisolone
How do you manage oedema?
Low salt intake, low protein diet
How do you manage hyperlipidaemia?
Statins if prolonged
How do you manage the hypercoagulable state?
Prophylactic anticoagulants like apixaban, LMWH, warfarin
How do you manage infection?
Antibiotics
What is the main cause of nephrotic syndrome in kids?
Minimal change disease
What are causes of nephrotic syndrome in adults?
Membranous glomerulonephritis, focal segmental glomerulosclerosis, diabetic nephropathy, SLE, amyloidosis, Hep B or C, HIV
