Nephrotic syndrome

Question 1

Nephrotic syndrome characterised by what 4 things

Answer 1

hypoalbuminaemia
proteinuria (>3.5g/day)
dyslipidaemia
salt and water retention (lead to oedema)

Question 2

explain fully why we get hyperlipidaemia in nephrotic syndrome?

Answer 2

Increased Lipoprotein synthesis As direct consequence of low plasma albumin.

LDL increases due to upreg of a liver serine protease PCSK9.

can complete this card from kumar/clarke book

Question 3

What is the initial management for nephrotic syndrome.

Answer 3

Dietary sodium restriction and thiazide diuretic.

if unresponsive, may require furesimide (40-120mg daily and amiloride 5mg daily +monitor k conc regularly).

May need to give IV diuretics due to mucosal oedema causing malabsorption.

Sometimes oedema is accepted if hypovolaemic, as don’t want to cause postural hypotension

Question 4

Management of nephrotic – protein intake
albumin infusion
hypercoag state

Answer 4

Protein intake should remain normal to reduce proteinurea
Alb infusion only given to those who are diuretic resistant and those with oliguria and uraemia in absence of a lot of glomerular damage

They are in hypercoagubale state because they are loosing clotting agents (antithrombin) in the urine, and increased hepatic production of fibrinogen. So avoid prolonged bed rest, as thromboembolism is risk.

Question 5

Describe sepsis, lipid abnormalities and ACEi/ARBs as management for nephrotic

Answer 5

Sepsis - the patients very likely to develop infection due to loss of immunoglobulin in urine and so need to treat infections very aggressively early on.

Treat hyper lip/hypercholesterolaemia with statins - otherwise CVD risk

ACEi/ ARBs given to nearly all types of glomerulonephropathy, because they reduce the glomerular capillary filtration pressure and reduce loss of protein.