Nephrotic syndrome

Question 1

Nephrotic syndrome

Answer 1

Basement membrane in glomerulus becomes highly permeable to protein

Allows protein to leak from blood into urine

Most common between age 2-5

Question 2

Triad presentation

Answer 2

Low serum albumin (<30g/L)

High urine protein content (>3 on dipstick)

Oedema

Question 3

Other features

Answer 3

Deranged lipid profile

High BP

Hyper-coagulability

Question 4

Causes

Answer 4

Most common cause in children in minimal change disease (no underlying condition or pathology)

Secondary to intrinsic kidney disease (focal segmental glomerulonephritis, membranoproliferative glomerulonephritis)

Secondary to systemic illness (Henoch schonlein purpura, diabetes, infection)

Question 5

Minimal change disease

Answer 5

Renal biopsy and standard microscopy doesn’t detect any abnormalities

Urinalysis shows small molecular weight proteins and hyaline casts

Management with corticosteroids

Good prognosis

Question 6

Management of nephrotic syndrome

Answer 6

High dose steroids (if steroid resistant use ACEi and immunosuppressants)

Low salt diet

Diuretics to treat oedema

ALbumin infusions

Antibiotic prophylaxis in severe cases

Question 7

Complications

Answer 7

VTE (loss of antithrombin III and plasminogen in urine)

Hyperlipidaemia (ACS/ stroke)

CKD

Infection risk as urinary immunoglobulin loss

Hypocalcaemia

Hypovolaemia as fluid leaks from intravascular space into interstitial space (oedema and low BP)

Relapse