Nephrotic Syndrome

Question 1

What is nephrotic syndrome?

Answer 1

Breakdown in selectivity of glomerular filtration barrier leading to protein leak.

Question 2

What are the hallmark signs of nephrotic syndrome?

Answer 2

Proteinuria (>3.5g/day)

Hypoalbuminemia (<30g/L)

Oedema

Hyperlipidaemia

Question 3

List 3 primary causes of nephrotic syndrome

Answer 3

Minimal change disease
Focal segmental glomerulosclerosis (FSGS)
Membranous nephropathy

Question 4

List 5 secondary causes of nephrotic syndrome

Answer 4

DM
SLE
Amyloidosis
Infection: HIV, Hep B + C
Drugs: NSAIDs, gold therapy

Question 5

What is the underlying mechanism of nephrotic syndrome?

Answer 5

damage to glomerular BM + podocytes, leading to increased permeability to proteins.

Question 6

What results from proteinuria in nephrotic syndrome?

Answer 6

Proteinuria results in hypoalbuminaemia + subsequent oedema due to reduced plasma oncotic pressure

Question 7

What predisposes to thrombosis in nephrotic syndrome?

Answer 7

Loss of antithrombin-III, protein C + S
+
associated rise in fibringogen

Question 8

What are 5 complications of nephrotic syndrome?

Answer 8

Increased risk of thromboembolism
Hyperlipidaemia
CKD
Increased risk of infection
Hypocalcaemia

Question 9

How may thromboembolism due to nephrotic syndrome manifest?

Answer 9

DVT/ PE
Renal vein thrombosis resulting in sudden deterioration in renal function

Question 10

What increases risk of infection in nephrotic syndrome?

Answer 10

Urinary loss of immunoglobulin

Question 11

What causes hypocalcaemia in nephrotic syndrome/

Answer 11

Vit D + binding protein lost in urine