Nephrotic syndrome

Question 1

Causes of nephrotic syndrome

Answer 1

• Minimal change disease (most common in children)
• Membranous Nephropathy. (most common in adults)
• FSGS
• MCGN
• Amyloidosis
• Diabetes
• Lupus.

Question 2

Triad of features nephrotic syndrome

Answer 2

Proteonuria
(Peripheral) oedema
Hypoalbuminaemia

Question 3

What other features of nephrotic syndrome

Answer 3

*hypercoagulability - loss of antithrombin III - prone to thrombotic complications
*reduced immunity - loss of immunoglobulins

Question 4

Minimal change - pathology + electron microscopy.

Answer 4

** Fusion of podocytes -> glomerular hyperfiltration (can progress to CKD)

** electron micrsopy - fusion of podocytes foot processes.

Question 5

Minimal change causes

Answer 5

1. Idiopathic
2. IL-13 + IL-4 produced by abnormal t cells
3. Drugs - NSAIDs.
4. Lymphoma
5. Viral infection- EBV, HIV

Question 6

Minimal change TX + Prognosis

Answer 6

• cyclophosphamide
• 1/3 rule - one episode, infrequent relapses and frequent relapse stops before adulthood.

Question 7

Amyloidosis presentation

Answer 7

General: heavy proteinuria +/- nephrotic syndrome +/- renal failure.
With sob, weight loss, fatigue.
Associated - RA, AS, crohns, myeloma, non hod lymphoma.

Question 8

Amyloidosis - pathology + treatment

Answer 8

1. AA amyloid - deposits of acute phase reactants serum amyloid A
2. AL amyloid (most severe) - fibril deposition from light chain immunoglobulins.

1a. Treat underlying inflammatory disorder

2a. Anti- myeloma therapy - combo chemo (dexamethasone).

Question 9

Amyloidosis investigation- staining

Answer 9

Stains w congo red (apple green birefringence under polarised light)

Question 10

Diabetic nephropathy - clinical features

Answer 10

• microalbuminuria (protein too low to be detected by urine dipstick)

Later on:
* heavy proteinuria +/- nephrotic syndrome
* progressive decline in GFR.