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Urinary > Nephrotic syndrome > Flashcards

Nephrotic syndrome Flashcards

1
Q

What makes up the triad of nephrotic syndrome?

A

Proteinuria (> 3g/24hr) causing
Hypoalbuminaemia (< 30g/L)
Oedema

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2
Q

What is nephrotic syndrome?

A

A clinical syndrome that arises secondary to increased permeability of serum protein through a damaged basement membrane in the renal glomerulus.

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3
Q

What is the most common cause of nephrotic syndrome in adults?

A

Membranous glomerulonephritis

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4
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

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5
Q

What is another common cause of nephrotic syndrome?

A

Focal segmental glomerulosclerosis

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6
Q

What are the possible causes of minimal change disease?

A

Idiopathic
NSAIDs
Hodgkin’s lymphoma
Infectious mononucleosis

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7
Q

How is minimal chnage diagnosed?

A

Renal biopsy and electron microscopy

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8
Q

What might you see on microscopy of someone with minimal change?

A

Fusion of podocytes and effacement of foot processes

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9
Q

What is the management of minimal change?

A

Oral steroids

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10
Q

What might you consider giving a minimal chnage patient if there was no response to steroids?

A

cyclophosphamide

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11
Q

What is the prognosis of minimal change disease?

A

1/3 have just one episode
1/3 have infrequent relapses
1/3 have frequent relapses which stop before adulthood

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12
Q

What is Membranous glomerulonephritis the most common form of?

A

Glomerulonephrities in adults

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13
Q

What are the 2 categories of aeitology of membraneous glomeruonephritis?

A

Primary and secondary

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14
Q

What is the primary cause of membranous glomerulonephritis?

A

Idiopathic

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15
Q

What are the secondary causes of membranous glomerulonephritis?

A
  • malignancy
  • infection
  • drugs
  • autoimmune disease
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16
Q

What malignancies is membranous glomerulonephritis associated with?

A

Prostate
Lung
Lymphoma
Leukaemia

17
Q

What infection is membranous glomerulonephritis associated with?

A

Hepatitis B
Malaria

18
Q

What drugs is membranous glomerulonephritis associated with?

A

Penicillamine
Gold
NSAID’s

19
Q

What autoimmune diseases is membranous glomerulonephritis associated with?

A

SLE
rheumatoid arthritis
sarcoidosis
Sjogrens

20
Q

What would you see on urinanalysis of someone with membranous glomerulonephritis?

A

Proteinuria

21
Q

What would you see on a renal biopsy of someone with membranous glomerulonephritis?

A

Basement membrane is thickened with subepithelial electron dense deposists.
(immune complex deposits)

Creates a ‘spike and dome’ appearance on silver stain

22
Q

What can be used in the medical management of membranous glomerulonephritis?

A

Furosemide
ACEi or ARB
Corticosteroid and another agent (cyclophosphamide)

23
Q

What is the function of ACEi or ARBs in the management of membranous glomerulonephritis?

A

Control blood pressure and proteinuria

24
Q

What is the function of a corticosteroid and cyclophosphamide?

A

Immunosuppression

25
Q

What is the prognostic rule for membranous glomerulonephritis?

A

one-third: spontaneous remission
one-third: remain proteinuric
one-third: develop ESRF

26
Q

What are good prognostic indications in someone with membranous glomerulonephritis?

A

Female
Young at time of presentation
Asymptomatic proteinuria

27
Q

Who is usually affected by Focal Segmental Glomerulosclerosis?

A

Young adults
Afro-caribbean population

28
Q

What are the main causes of focal segmental glomerulosclerosis?

A

secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy
HIV
Sickle cell
Alport’s syndrome

29
Q

What would you see on renal biopsy in someone with focal segmental glomerulosclerosis?

A
  • light microscopy —> focal and segmental scleroris (scarring) and hyalinosis
  • electron microscopy —> effacement of foot processes
30
Q

What is the management of focal segmental glomerulosclerosis?

A

steroids +/- immunosuppressants
Treat HIV if that is the cause

31
Q

In who does focal segmental glomerulosclerosis have a high recurrence rate?

A

Kidney transplant patients

32
Q

What is the prognosis of focal segmental glomerulosclerosis?

A
  • can cause CKD
  • 2/3rd experience deterioration of renal function

Urinary (38 decks)

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