Nephrotic Syndrome

Question 1

What is the triad in nephrotic syndrome?

Answer 1

Proteinuria, hypoalbuminaemia, oedema. (also hyperlipidaemia)

Question 2

In which groups is nephrotic syndrome more common?

Answer 2

Asian children between 2-6 years old.

Question 3

What are the causes of nephrotic syndrome?

Answer 3

1. Minimal change disease (80%)
2. Focal segmental glomerulosclerosis
3. Membranoproliferative glomerulonephritis

Question 4

How can you distinguish between these three conditions in nephrotic syndrome?

1. Minimal change disease
2. Focal segmental glomerulosclerosis
3. Membranoproliferative glomerulonephritis

Answer 4

1. No change on light microscopy
2. Sclerosis of podocytes in some of the glomeruli
3. Proliferation of glomerular basement membrane and mesangial cells

Question 5

What is this a presentation of?

Insidious onset periorbital oedema, scrotal swelling, shock (low intravascular volume), frothy urine.

Answer 5

Nephrotic syndrome

Question 6

How is nephrotic syndrome diagnosed?

Answer 6

1. Dip urine to distinguish allergy
2. High early morning ACR/PCR
3. LFTs - low albumin, lipids - high

Question 7

When is a biopsy needed in nephrotic syndrome?

Answer 7

1. Age <1 years or >8 years
2. HTN
3. Gross haematuria
4. Proteinuria >4 weeks post steroids

Question 8

What is the management of nephrotic syndrome?

Answer 8

1. fluid restriction 1000 ml per day
2. diuretics if very oedematous and no evidence of hypovolemia
3. prednisolone for 4 weeks then wean over 4 months

Question 9

What is there a high risk of in nephrotic syndrome and why?

Answer 9

VTE because of loss of antithrombin III