Nephrotic Syndrome

Question 1

Triad of nephrotic syndrome:

Answer 1

◦ PROTEINURIA; >3.5g/24 hours (would give foamy urine)
◦ HYPOALBUMINAEMIA: <30g/L
◦ PERIPHERAL OEDEMA
◦ Hyperlipidaemia is also commonly seen

Question 2

Aetiology of nephrotic syndrome

Answer 2

• Split into Primary (direct damage to the glomerulus) and Secondary (secondary to systemic disease) conditions:
• Primary:
‣ Minimal Change Disease:
◦ The most common cause of nephrotic syndrome in children
◦ Idiopathic cause, can be associated with NSAIDs, lithium and Hodgkin’s lymphoma
◦ Can treat with prednisolone
‣ Membranous Neuropathy:
◦ Common cause in adults
◦ Can have primary (autoimmune) or secondary (malignancy) cause
◦ May be able to detect the auto-antibodies (anti-phopholipase) or see thickened glomerular basement membrane
◦ Can take ACEi or ARB to manage BP, may need immunomodulators
‣ Focal Segmental Glomeruolosclerosis (FSGS)
• Secondary:
• Diabetic nephropathy
• Amyloid nephropathy

Question 3

Pathophysiology of Nephrotic syndrome

Answer 3

• Problem with the filtration barrier of the kidney would lead to the proteinuria

Question 4

History and Examination of nephrotic syndrome

Answer 4

• Generalised pitting oedema: most likely at ankles, can be seen around eyes, can be rapid
• Foamy/Cloudy urine: Can indicate proteinuria
• May have signs of malignancy
• May have leukonychia: due to hypoalbuminaemia

Question 5

Investigations for nephrotic syndrome

Answer 5

• Urine dip
• Renal function
• LFTs (low serum albumin)
• Lipid profile

Question 6

Management of nephrotic syndrome

Answer 6

• Reduce oedema: Fluid and salt restriction. Diuresis with loop diuretics (e.g furosemide)
• Treat underlying cause: Adults need renal biopsy. Corticosteroids can induce remission
• Reduce proteinuria: ACEi or ARB can reduce proteinuria
• Complications: Risk of thromboembolism due to increased clotting factors and platelet abnormalities. Hyperlipidaemia