Nephrotic Syndrome Flashcards
What are the direct mechanism and indirect mechanism in NS?
Direct: injury to podocyte
Indirect: changed architecture like scarring and deposition of matrix or other elements (amyloid)
Clinical features of NS?
- Overt proteinuria >3.5gm/24 hours
Urine frothy - Hypoalbuminaemia <30g/dl
- Odema and generalized fluid retention
- Possible intravascular volume depletion with hypotensionor intravascular expansion with hypertension
Level of proteinuria for children to be NS?
> 2g/24 hrs
Name of NS
MCD
Focal segmental glomerulosclerosis
Membranous nephropathy
Amyloid
Diabetic nephropathy
Condition causing Nephro-Nephritic presentation in glomerular disease?
SLE
IgA nephropathy
MCGN
Diabetic nephropathy
FSGS
ACR <3.5 female, <2.5 male
PCR <25
Interpretation
Normal
Moderately elevated proteinuria
Microalbuminuria
ACR 3.5-30
PCR 25-50
Dipstick proteinuria
Overt proteinuria
ACR 30-70
PCR 50-100
Dipstick + - ++
Glomerular disease more likely
Equivalent to >1gm/24hrs
Indication for dialysis
ACR 70-300
PCR 100-350
Dipstick ++ - +++
Nephrotic range
Equivalent to >3.5 gm/24hours
Almost always glomerular disease
ACR >300
PCR >350
Dipstick +++ - ++++
What is the hallmark of glomerular disease?
Proteinuria
NS
1. Children
2. Young
3. Middle aged to older
4. Older patients
5. Any age but rarely <10 years from diagnosis of T1DM
- MCD
- FSGS
- MN
- Amyloid
- Diabetic Nephropathy
Investigations for MN
Antiphspolipase a2 receptor antibody
Hep B,C HIV, ANA, dsDNA
What is the early and universal feature for NS?
Renal sodium retention
Investigation for NS?
Renal biopsy
Which NS is most common in Children?
MCD
Does MCD require renal biopsy?
When to do biopsy?
No
When fails to response high dose glucocortocoids
Investigation for proteinuria
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
what are the consequences of NS?
hypoalbuminaemia
avid soidum retention
hypercholesterolaemia
hypercoagulabity
infection
why hypoalbuminaemia occurs in NS?
and consequence?
urinary protein loss exceed synthetic capacity of liver
reduced oncotic pressure, oedema
why avid sodium retention occur in NS?
consequence?
Rx
secondary hyperaldosteronism
oedema
diuretics and low sodium diet
Why hypercholesterolemia occur in NS?
consequences?
RX?
due to low oncotic pressure, lipoproteins synthesis increases by liver
high rate of atherosclerosis
statins and ezetimibe
cause of hypercoagulability in NS?
Consequence
Rx
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
causes of infection in NS?
consequence
Rx
Hypogammaglobinemia due to urinary loss of immunoglobulins
pneumococcal and meningococcal infection
Rx: consideration of vaccinations
