nephrotic syndrome Flashcards
nephrotic range proteinuria
> 3.5 g/24 hours
nephrotic syndrome hallmarks
nephrotic range proteinuria
hypoalbuminemia
edema
normal urinary protein excretion
<150 mg/day
dipstick urinalysis is sensitive for what protein?
albumin
most common cause of nephrotic syndrome in children
minimal change disease
possible cause of benign proteinuria
post exercise
orthostatic
nephrotic syndrome urinalysis
proteinuria
frothy urine
fatty casts on microscopy
nephrotic syndrome pathophys
damage to podocytes on epithelial side of glomerulus compromises the filtration barrier leading to massive protein loss in urine
causes of minimal change disease
drugs (NSAIDS) allergies Hodgkins hematologic malignancies Infection
minimal change disease treatment
glucocorticoids
minimal change disease biopsy findings
light microscopy shows no changes but EM shows flat podocytes and loss of GBM
focal segmental glomerulosclerosis pathophys
an unknown circulating factor leads to sclerosis of the glomeruli of some nephrons damaging the podocytes
primary FSGS cause
unknown, random
secondary FSGS causes
heroin
HIV
obesity
HTN
FSGS treatment
steroids (do not reverse scarring)
immunosuppression in resistant disease
ACEi/ARB, statins
primary membranous nephropathy pathophys
anti-PLA2R antibodies form immune complexes that lead to Podocyte injury
minimal change disease pathophys
cytokine mediated damage of podocytes
secondary membranous nephropathy causes
infections
autoimmune diseases
tumors
rx
renal biopsy showing thick basement membrane with subepithelial deposits along the basement membrane
membranous nephropathy
membranous nephropathy treatment
steroids and cyclophosphamide
what happens if nephrotic syndrome is not treated?
will likely progress to ESRD
primary amyloidosis pathophys
deposition of amyloid in mesangium that takes over membrane
primary amyloidosis treatment
treat underlying systemic disease
diabetic nephropathy pathophys
chronic hyperglycemia leads to GBM thickening and eventually sclerosis, decreasing GFR
____ can cause nephrotic lesions in pregnancy
preeclampsia (HTN, proteinuria)
treatment of edema in nephrotic syndrome
loop diuretics
sodium restriction
fluid restriction
treatment of proteinuria in nephrotic syndrome
RAAS inhibitor like ACEi/ARBs
all pts with nephrotic syndrome are at increased risk of ____ because of ____
thromboembolism
protein loss/hypoalbuminemia
why does nephrotic syndrome cause edema?
loss of proteins in blood (peeing them out) leads to increased interstitial fluid
additional test to get if lupus nephritis is suspected
ANA
membranous nephropathy is commonly seen in _____
caucasian adult males
viral hepatitis can cause which type of nephrotic syndrome?
membranous nephroapthy
why is DVT a possible complication of nephrotic syndrome?
there is a loss or protein C, S and antithrombin III and overproduction of clotting proteins
