Nephrotic syndrome Flashcards
What makes up the triad of nephrotic syndrome?
Proteinuria (> 3g/24hr) causing
Hypoalbuminaemia (< 30g/L)
Oedema
What is nephrotic syndrome?
A clinical syndrome that arises secondary to increased permeability of serum protein through a damaged basement membrane in the renal glomerulus.
What is the most common cause of nephrotic syndrome in adults?
Membranous glomerulonephritis
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
What is another common cause of nephrotic syndrome?
Focal segmental glomerulosclerosis
What are the possible causes of minimal change disease?
Idiopathic
NSAIDs
Hodgkin’s lymphoma
Infectious mononucleosis
How is minimal chnage diagnosed?
Renal biopsy and electron microscopy
What might you see on microscopy of someone with minimal change?
Fusion of podocytes and effacement of foot processes
What is the management of minimal change?
Oral steroids
What might you consider giving a minimal chnage patient if there was no response to steroids?
cyclophosphamide
What is the prognosis of minimal change disease?
1/3 have just one episode
1/3 have infrequent relapses
1/3 have frequent relapses which stop before adulthood
What is Membranous glomerulonephritis the most common form of?
Glomerulonephrities in adults
What are the 2 categories of aeitology of membraneous glomeruonephritis?
Primary and secondary
What is the primary cause of membranous glomerulonephritis?
Idiopathic
What are the secondary causes of membranous glomerulonephritis?
- malignancy
- infection
- drugs
- autoimmune disease
What malignancies is membranous glomerulonephritis associated with?
Prostate
Lung
Lymphoma
Leukaemia
What infection is membranous glomerulonephritis associated with?
Hepatitis B
Malaria
What drugs is membranous glomerulonephritis associated with?
Penicillamine
Gold
NSAID’s
What autoimmune diseases is membranous glomerulonephritis associated with?
SLE
rheumatoid arthritis
sarcoidosis
Sjogrens
What would you see on urinanalysis of someone with membranous glomerulonephritis?
Proteinuria
What would you see on a renal biopsy of someone with membranous glomerulonephritis?
Basement membrane is thickened with subepithelial electron dense deposists.
(immune complex deposits)
Creates a ‘spike and dome’ appearance on silver stain
What can be used in the medical management of membranous glomerulonephritis?
Furosemide
ACEi or ARB
Corticosteroid and another agent (cyclophosphamide)
What is the function of ACEi or ARBs in the management of membranous glomerulonephritis?
Control blood pressure and proteinuria
What is the function of a corticosteroid and cyclophosphamide?
Immunosuppression
What is the prognostic rule for membranous glomerulonephritis?
one-third: spontaneous remission
one-third: remain proteinuric
one-third: develop ESRF
What are good prognostic indications in someone with membranous glomerulonephritis?
Female
Young at time of presentation
Asymptomatic proteinuria
Who is usually affected by Focal Segmental Glomerulosclerosis?
Young adults
Afro-caribbean population
What are the main causes of focal segmental glomerulosclerosis?
secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy
HIV
Sickle cell
Alport’s syndrome
What would you see on renal biopsy in someone with focal segmental glomerulosclerosis?
- light microscopy —> focal and segmental scleroris (scarring) and hyalinosis
- electron microscopy —> effacement of foot processes
What is the management of focal segmental glomerulosclerosis?
steroids +/- immunosuppressants
Treat HIV if that is the cause
In who does focal segmental glomerulosclerosis have a high recurrence rate?
Kidney transplant patients
What is the prognosis of focal segmental glomerulosclerosis?
- can cause CKD
- 2/3rd experience deterioration of renal function
