Nephrotic Syndrome

Question 1

DDX of protienuria

Answer 1

1/ transient during febrile illness or excercise
2/ orthostatic
3/ nephrotic syndrome
4/GN
5/ abnormal glomerular basement membrane
6/ HTN

Question 2

Proteinuria

Answer 2

Protien to creatinine ratio
أقل من
20 mg/mmol
او أقل من 0.2

Question 3

Clinical course of steroid sensitive nephrotic syndrome

Answer 3

20% resolve directly after steroids
30% infrequent relapses
50% frequent relapses “ steroid dependant”

Question 4

Most common complication of nephrotic

Answer 4

Infections ex: peritonitis, septic artheritis, sepsis
Loss of protective immunoglobulins in urine

Question 5

TREATMENT OF NEPHROTIC SYNDROME

Answer 5

Coticosteroids in steroid sensitive 😂

Question 6

Nephrotic syndrome common in

Answer 6

More common in male than females and asians than caucasians

Question 7

Nephrotic syndrome associated with

Answer 7

Atopy

Question 8

Nephrotic syndrome precipetated by

Answer 8

Respiratory infections

Question 9

سؤال مهم جداااااا
Features suggesting steroid sensitive nephrotic syndrome

Answer 9

1/ age between 1 and 10 years
2/ no macroscopic hematuria
3/ normal blood pressure
4/ ✨normal complement levels C3
5/ normal renal function “ creatinine”

Question 10

ازاي بتدي steroids mangement في حالة nephrotic syndrome

Answer 10

🌟 Oral coticosteroids prednisolone
اول اربع اسابيع
60mg/m2 كل يووووووم

بعد اربع اسابيع
بقلل لأربعة
40mg/m2 يوم و يوم و لمدة اربع اسابيع برضو

Question 11

Investigations

Answer 11

🌟Dipstick urine pritein اكتر من 3
🌟CBC ((( infectiooon)))
و لو لقيت في ال cbc هيموجلوبين عالي يبقي في volume depletion متماشي مع nephrotic
🌟 Complement levels C3, c4
Nephrotic syndrome ⏩normal
PSGN ⏩ C3 LOW
SLE⏩ BOTH C3 & C4 LOW
🌟Antistreptolysin O
Anti-DNAse B titre
Troat swab or culture
👽TO DIFFERENCIATE FROM PSGN
🌟Urine output
🌟 Blood albumin
🌟 Electrolytes
🌟🔥Hepatitis B & C (secondry cause of nephrotic syndrome)

Question 12

Indications of renal biobsy in nephrotic syndrome

Answer 12

1/⚡ persistant steroid resistant after 4-6 weeks
2/ RAPID PROGRESSIVE NEPHROTIC SYNDROME
3/ Atypical features ex : HTN & macroscopic hematuria & low C3
4/ ATYPICAL AGE presentation
normal (1- 10 years)

Question 13

Complications of nephrotic syndrome

Answer 13

🚫Hypovolemia
🚫Thrombosis
🚫Infection
🚫Hypercholesterolaemia

Question 14

Signs of hypovolemia

Answer 14

Abdominal pain
Peripheral vasoconstriction
Urinary sodium retention ( low urinary sodium أقل من عشر مللي مول لكل لتر)
High hemoglobin concentration

Question 15

ازاي اعالج hypovolemia

Answer 15

🚫Child at risk of vascular thromposis and shock
💉 INTRAVENOUS FLUIDS
0.9 saline or 4.5 % ALBUMIN
💉
لو الحالة SEVERE هديله IV 20% ALBUMIN
و معاه FUROSEMIDE
🚫🚫🚫
ال ALBUMIN الكتير ممكن يعمل PULMONARY EDEMA & HTN
fluid over load
🚫🚫🚫
FUROSEMIDE may worse hypovolemia

Question 16

ليه بيحصل thrombosis

Answer 16

1.loss of antithrombin 3
2. Steroid therapy may induce thrombocytosis
3. Increased synthesis of clotting factors
4. Increased blood viscosity

Question 17

Causitive organism of spontaneous peritonitis

Answer 17

Capsulated organism pneumococcus

Question 18

ممكن ادي ايه عشان ال infection

Answer 18

💉Pneumococcal and seasonal influenza vaccination
💉Penicillin prophylaxis
💉 Acyclovir for chicken pox and shingles

Question 19

Steroid resistant nephrotic syndrome

Answer 19

Renal biobsy indication
Diuretics
Salt restrictions
ACEI
NSAIDS

Question 20

Steroid resistant nephrotic syndrome

Answer 20

30% of cases ⏩ mutations in genes of podocyte function in glomerular basement membrane

Question 21

CONGENITAL NEPHROTIC SYNDROME

Answer 21

🔥AT first 3 months of life
🔥 Autosomal recessive
🔥Consanguinity
🔬Genetic testing recommended as 70 % due to genetic defect
🚫☠️
Hypo albuminaemia
Progressive chronic kidney disease
🔪 Unilateral nephrectomy for control and dialysis
Old enough for renal transplantation