Nephrotic Syndrome Flashcards
Ptn presented with hematuria + protein uria + azotemia and salt and water retention, what’s the most likely diagnosis?
( Focal segmental glomerulosclerosis ) is the most common cause of idiopathic nephrotic syndrome in adults
What is renovascular hypertension?
Is a BP elevation due to partial or complete occlusion of one or more renal arteries
How to diagnose a young adult ptn with 2ry hypertension?
By duplex US
What are the most common side effects of furosemide?
Hypokalemia , it can lower potassium, sodium, magnesium which can lead to hearth rhythm abnormalities
What is the most common idiopathic cause of nephrotic syndrome in children?
Minimal change disease ( MCD ) the pathogenesis is unknown but results in disruption of the protein charge barrier
What is the most common cause of nephrotic syndrome in adults?
FSGS (> black men ) , the. 2nd Is membraneous nephropathy ( MN )
What will you see on a renal biopsy of an IV drug abuser or HIV ptn?
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)
How can you treat a child with minimal glomerulonephritis?
Usually respond well to steroids and it will not cause kidney failure
Membranous nephropathy is twice in male than female, true or false?
True
Q.what the most likely outcome for young ptn with minimal change disease?
40% spontaneous recovery, 90% recovery with steroids for 2 weeks
N. In nephrotic syndrome the proteinuria is >….g/24h while serum albumin is
Proteinuria > 3.5 , serum albumin < 3
N. What’s the treatment for nephrotic disease? 4
1- ACE inhibitors or ARBs / 2- control BP < 130 / 3-loop diuretics / 4- statins for hyperlipidemia
N. What are the 1ry causes of nephrotic syndrome? 4
Minimal change disease, focal segmental glomerulosclerosis , membranous nephropathy, membranolrolifirative glomerulonephritis
N. What are the 2ry causes of nephrotic syndrome? 3
Amyloidosis, diabetic nephropathy, SLE
N. What gender and age group is mostly affected by nephrotic syndrome?
Men > 40 years ( but can occur in all ages and gender )
N. What are the causes of membranous nephropathy?
1ry 70% , 2ry as :
Infections( hepatitis B & C, syphilis) , Malignancy in lung, breast, GIT ( most common) , Autoimmune (SLE) , drugs: gold, penicillamine, NSAIDS
N. PMN is an autoimmune disease mediated by …… antibody directed to the … type phospholipase A2 receptor
IgG, M type ,
N. What’s the treatment for membranous nephropathy?
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.
N. What are the Causes of minimal change disease? 3
Idiopathic, drugs, ( NSAIDS, antimicrobial, lithium, ) neoplasm ( Hodgkin and non-Hodgkin lymphoma , thymoma, leukemia )
N. Minimal change disease respond well to…… with good prognosis. untreated MCD is associated with …….&………
Steroids, infection & thromboembolism
N. What’s the treatment for MCD?
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
N. In what type of nephrotic syndrome do you see decrease renal cell mass or sickle cell anemia?
FSGS
Heroine and pamidronate can cause 2ry…….?
FSGS
What are the 2ry nephrotic syndromes?
Amyloidosis, diabetic nephropathy, SLE
