Nephrotic syndrome Flashcards
When does nephrotic syndrome occur?
When the basement membrane in the glomerulus becomes highly permeable to protein
What does the permeable basement membrane allow?
It allows proteins to leak from the blood into the urine
When is nephrotic syndrome most common in children?
Between 2-5 years old
How does nephrotic syndrome present?
Frothy urine
Generalised oedema
Pallor
What is the classic triad of symptoms of nephrotic syndrome?
- proteinuria (> 1 g/m^2 per 24 hours)
- hypoalbuminaemia (< 25 g/l)
- oedema
What features occur in a patient with nephrotic syndrome?
- Deranged lipid profile
- High blood pressure
- Hyper-coagulability, with an increased tendency to form blood clots
What lipid profile would suggest nephrotic syndrome?
High levels of:
Cholesterol
Triglycerides
Low density lipoproteins
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
How does nephrotic syndrome present in minimal change disease?
It occurs in isolation, without any clear underlying condition or pathology.
What are underlying causes that nephrotic syndrome can occur secondary to?
It can occur secondary to:
- Intrinsic kidney disease
- Underlying systemic illness
What intrinsic kidney diseases can nephrotic syndrome occur secondary to?
- Focal segmental glomerulosclerosis
* Membranoproliferative glomerulonephritis
What systemic illness can nephrotic syndrome occur secondary to?
- Henoch schonlein purpura (HSP)
- Diabetes
- Infection, such as HIV, hepatitis and malaria
What can be used to diagnose minimal change disease?
Urinalysis (analysis of the urine)
What might you see in the urine of someone with minimal change disease?
- Small molecular weight proteins
* Hyaline casts.
What is useless for the diagnosis of minimal change?
A renal biopsy and standard microscopy
What is used in the management of minimal change disease?
Corticosteroids- prednisolone
What is the prognosis of minimal change disease?
Good prognosis
Most children make a full recovery
However it may reoccur.
What can be given to treat the oedema?
Diuretics- Furosemide
How long are steroids given for nephrotic syndrome?
4 weeks
Child then needs weaned off them for 8 weeks
What are possible complications of minimal change disease?
- Spontaneous peritonitis
- Thrombosis
- Recurrent minimal change disease
- Hypertension
What is the classic presentation of a child with minimal change disease?
2 – 5 year old child with oedema, proteinuria and low albumin
What is the conservative management of minimal change disease?
Fluid restriction and reduced salt intake
What are the main features of nephrotic syndrome?
- Significant proteinuria
- Oedema
- Hypoalbuminaemia
- Hyperlipidaemia
