Nephrotic Syndrome

Question 1

Ptn presented with hematuria + protein uria + azotemia and salt and water retention, what’s the most likely diagnosis?

Answer 1

( Focal segmental glomerulosclerosis ) is the most common cause of idiopathic nephrotic syndrome in adults

Question 2

What is renovascular hypertension?

Answer 2

Is a BP elevation due to partial or complete occlusion of one or more renal arteries

Question 3

How to diagnose a young adult ptn with 2ry hypertension?

Answer 3

By duplex US

Question 4

What are the most common side effects of furosemide?

Answer 4

Hypokalemia , it can lower potassium, sodium, magnesium which can lead to hearth rhythm abnormalities

Question 5

What is the most common idiopathic cause of nephrotic syndrome in children?

Answer 5

Minimal change disease ( MCD ) the pathogenesis is unknown but results in disruption of the protein charge barrier

Question 6

What is the most common cause of nephrotic syndrome in adults?

Answer 6

FSGS (> black men ) , the. 2nd Is membraneous nephropathy ( MN )

Question 7

What will you see on a renal biopsy of an IV drug abuser or HIV ptn?

Answer 7

Focal segmental glomerulosclerosis ( aggressive form of nephrotic syndrome) sclerosis and hyalinization with focal deposits of igM and C3. That is usually is resistant to steroid therapy ( poor prognosis)

Question 8

How can you treat a child with minimal glomerulonephritis?

Answer 8

Usually respond well to steroids and it will not cause kidney failure

Question 9

Membranous nephropathy is twice in male than female, true or false?

Answer 9

True

Question 10

Q.what the most likely outcome for young ptn with minimal change disease?

Answer 10

40% spontaneous recovery, 90% recovery with steroids for 2 weeks

Question 11

N. In nephrotic syndrome the proteinuria is >….g/24h while serum albumin is

Answer 11

Proteinuria > 3.5 , serum albumin < 3

Question 12

N. What’s the treatment for nephrotic disease? 4

Answer 12

1- ACE inhibitors or ARBs / 2- control BP < 130 / 3-loop diuretics / 4- statins for hyperlipidemia

Question 13

N. What are the 1ry causes of nephrotic syndrome? 4

Answer 13

Minimal change disease, focal segmental glomerulosclerosis , membranous nephropathy, membranolrolifirative glomerulonephritis

Question 14

N. What are the 2ry causes of nephrotic syndrome? 3

Answer 14

Amyloidosis, diabetic nephropathy, SLE

Question 15

N. What gender and age group is mostly affected by nephrotic syndrome?

Answer 15

Men > 40 years ( but can occur in all ages and gender )

Question 16

N. What are the causes of membranous nephropathy?

Answer 16

1ry 70% , 2ry as :
Infections( hepatitis B & C, syphilis) , Malignancy in lung, breast, GIT ( most common) , Autoimmune (SLE) , drugs: gold, penicillamine, NSAIDS

Question 17

N. PMN is an autoimmune disease mediated by …… antibody directed to the … type phospholipase A2 receptor

Answer 17

IgG, M type ,

Question 18

N. What’s the treatment for membranous nephropathy?

Answer 18

Same as nephrotic syndrome. But in case it doesn’t work then give immune targeted therapy as : cyclophosphamide with prednisone for 6 months, if ptn can’t tolerate this mix the. Give cyclosporine with low dose prednisone as an alternative. Alternatively you can give Rituximab ( monoclonal antibody to CD20 ) alone.

Question 19

N. What are the Causes of minimal change disease? 3

Answer 19

Idiopathic, drugs, ( NSAIDS, antimicrobial, lithium, ) neoplasm ( Hodgkin and non-Hodgkin lymphoma , thymoma, leukemia )

Question 20

N. Minimal change disease respond well to…… with good prognosis. untreated MCD is associated with …….&………

Answer 20

Steroids, infection & thromboembolism

Question 21

N. What’s the treatment for MCD?

Answer 21

Steroids ( ACEI, ARBs & statins are not given in initial episode) , ➡️ cyclosporine is given for steroids resistant ptn ➡️ cyclophosphamide is given for steroids dependent ptn ➡️ mycophenolate mofetil and Rituximab are given also for steroids dependent ptn

Question 22

N. In what type of nephrotic syndrome do you see decrease renal cell mass or sickle cell anemia?

Answer 22

FSGS

Question 23

Heroine and pamidronate can cause 2ry…….?

Answer 23

FSGS

Question 24

What are the 2ry nephrotic syndromes?

Answer 24

Amyloidosis, diabetic nephropathy, SLE