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Nephrology > Nephrotic Syndrome > Flashcards

Nephrotic Syndrome Flashcards

1
Q

What are the direct mechanism and indirect mechanism in NS?

A

Direct: injury to podocyte
Indirect: changed architecture like scarring and deposition of matrix or other elements (amyloid)

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2
Q

Clinical features of NS?

A
  1. Overt proteinuria >3.5gm/24 hours
    Urine frothy
  2. Hypoalbuminaemia <30g/dl
  3. Odema and generalized fluid retention
  4. Possible intravascular volume depletion with hypotensionor intravascular expansion with hypertension
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3
Q

Level of proteinuria for children to be NS?

A

> 2g/24 hrs

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4
Q

Name of NS

A

MCD
Focal segmental glomerulosclerosis
Membranous nephropathy
Amyloid
Diabetic nephropathy

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5
Q

Condition causing Nephro-Nephritic presentation in glomerular disease?

A

SLE
IgA nephropathy
MCGN
Diabetic nephropathy
FSGS

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6
Q

ACR <3.5 female, <2.5 male
PCR <25
Interpretation

A

Normal

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7
Q

Moderately elevated proteinuria
Microalbuminuria

A

ACR 3.5-30
PCR 25-50

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8
Q

Dipstick proteinuria
Overt proteinuria

A

ACR 30-70
PCR 50-100
Dipstick + - ++

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9
Q

Glomerular disease more likely
Equivalent to >1gm/24hrs
Indication for dialysis

A

ACR 70-300
PCR 100-350
Dipstick ++ - +++

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10
Q

Nephrotic range
Equivalent to >3.5 gm/24hours
Almost always glomerular disease

A

ACR >300
PCR >350
Dipstick +++ - ++++

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11
Q

What is the hallmark of glomerular disease?

A

Proteinuria

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12
Q

NS
1. Children
2. Young
3. Middle aged to older
4. Older patients
5. Any age but rarely <10 years from diagnosis of T1DM

A
  1. MCD
  2. FSGS
  3. MN
  4. Amyloid
  5. Diabetic Nephropathy
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13
Q

Investigations for MN

A

Antiphspolipase a2 receptor antibody
Hep B,C HIV, ANA, dsDNA

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14
Q

What is the early and universal feature for NS?

A

Renal sodium retention

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15
Q

Investigation for NS?

A

Renal biopsy

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16
Q

Which NS is most common in Children?

A

MCD

17
Q

Does MCD require renal biopsy?
When to do biopsy?

A

No
When fails to response high dose glucocortocoids

18
Q

Investigation for proteinuria

A

Repeated proteinuria on dipstick
2 of 3 positive dipstick
Exclude UTI

Quantify
Substantial: protein= >1g, PCR >100,ACR >70
Then, renal biopsy

Moderate or low grade
Protein <1g, PCR<100, ACR<70
Hypertension
Abnormal renal function
F/h renal disease
Signs of systemic disease

Yes, renal biopsy
No, observation= urinanalysis, creatinine, blood pressure 6-12 months, re assess if anything changes

19
Q

what are the consequences of NS?

A

hypoalbuminaemia
avid soidum retention
hypercholesterolaemia
hypercoagulabity
infection

20
Q

why hypoalbuminaemia occurs in NS?
and consequence?

A

urinary protein loss exceed synthetic capacity of liver
reduced oncotic pressure, oedema

21
Q

why avid sodium retention occur in NS?
consequence?
Rx

A

secondary hyperaldosteronism
oedema
diuretics and low sodium diet

22
Q

Why hypercholesterolemia occur in NS?
consequences?
RX?

A

due to low oncotic pressure, lipoproteins synthesis increases by liver
high rate of atherosclerosis
statins and ezetimibe

23
Q

cause of hypercoagulability in NS?
Consequence
Rx

A

relative loss of inhibitors in lipoproteins synthesis (antithrombin III, protein C, protein S)
increase in liver synthesis of procoagulant factors

venous thromboembolism

Rx: prophylaxis of chronic and severe NS

24
Q

causes of infection in NS?
consequence
Rx

A

Hypogammaglobinemia due to urinary loss of immunoglobulins

pneumococcal and meningococcal infection

Rx: consideration of vaccinations

25
Q

what are the GN associated with antibody production according to the different site of Glomerulus?

A
  1. circulating immune complexes
    - C= cryoglobinemia
    - S= Serum sickness
    - E= Endocarditis
  2. Endothelium
    - Small vessel Vasculitis
    - ANCA (Serum)
  3. GBM
    - Goodpastures disease
    - Anti GBM antibody
  4. Mesangium
    - IgA nephropathy
  5. Podocyte
    - Membranous nephropathy
    - Anti phospholipase A2 receptor
  6. Planted antigen
    - SLE (ANA, anti dsDNA)
    - Post infectious GN
26
Q

What are the poor prognostic indicators in glomerular disease?

A
  1. Male sex
  2. Hypertension
  3. persistant or severe proteinuria
  4. elevated creatinine at time of presentation
  5. Rapid rate of decline in renal function
  6. Tubulo-interstitial fibrosis observed on renal biopsy.
27
Q

What are disease typically presents with NS?

A

MCD
FSGS
Secondary FSGS
MN

28
Q

Fulminant NS are??
indolent NS are??

A

Fulminant: MCD, FSGS
Inodent: MN, Secondary FSGS

29
Q

other causes of NS

A

Diabetic nephropathy
amyloid

30
Q

MCD involving age group?

A

at any age but children common

31
Q

pathogenesis of MCD

A

reversible dysfunction of Podocyte

32
Q

Investigation of MCD
findings

A

Renal biopsy
findings: normal on light microscopy
fusion of podocyte foot process on electron microscopy

33
Q

What are the associations of MCD?

A

atopy
drugs
NSAIDs, ADH, lithium, gold
haematological malignancy
hodgekin lymphoma, thymoma

Nephrology (3 decks)

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