Nephrotic syndrome

Question 1

What are the four defining characteristics of nephrotic syndrome?

Answer 1

Hypoalbuminaemia
Proteinuria >3.5g
Oedema
Dyslipidaemia

Question 2

What is the most common cause of nephrotic syndrome in children? How is it treated?

Answer 2

Minimal change nephropathy

Prednisolone, Ciclosporin, tacrolimus, cyclophosphamide

Question 3

How does focal segmental glomerulosclerosis present on light microscopy?

Answer 3

With segmental glomerulosclerosis

Question 4

What are the mainstay general treatments for nephrotic syndrome?

Answer 4

Statins
ACE inhibitors and Angiotensin II Receptor antagonists
Dietary sodium restriction
Loop diuretic/potassium channel blocker
Long term prophylactic anticoagulants
Normal protein intake

Question 5

How do ACE inhibitors and AII-ARs improve nephrotic syndrome?

Answer 5

Reduce proteinuria by reducing vasodilatation of efferent arteriole thus reducing glomerular capillary hydrostatic pressure

Question 6

What glomerular disease is associated with PLA2R autoantibodies?

Answer 6

Membranous glomerulopathy (when autoimmune or idiopathic cause)

Question 7

Identify four drugs which can cause secondary membranous glomerulopathy

Answer 7

Penicillamine, gold, NSAIDs, mercury

Question 8

As well as drugs what other causes of secondary Membranous glomerulopathy are there?

Answer 8

Infections
SLE, Thyroiditis
Cancers

Question 9

How does membranous glomerulopathy appear on microscopy?

Answer 9

Thick capillary loops and basement membrane spikes

Question 10

What protein is found in the urine with AL amyloidosis? Name three conditions this can be associated with

Answer 10

Bence-Jones Protein

Myeloma, Waldenstrom’s macroglobulinaemia, Non-Hodgkin Lymphoma

Question 11

Identify three investigations regarding amyloidosis diagnosis

Answer 11

Light microscopy- shows eosinophilic deposits
Scincitiography- shows progression of disease
Congo red staining- shows apple red refringence