Nephrotic syndrome

Question 1

What is nephrotic syndrome?

Answer 1

Where the basement membrane of the glomerulus becomes highly permeable to protein - allowing proteins to leak from the blood into the urine

Question 2

What are the common causes of nephrotic syndrome in adults?

Answer 2

Focal segmental glomerulosclerosis
Membranous nephropathy
Membranoproliferative glomerulonephritis
Diabetes
Amyloidosis

Question 3

What is the triad of nephrotic syndrome?

Answer 3

Proteinuria > 3g/24 hours
Hypoalbuminaemia < 30g/L
Oedema

Question 4

What is the clinical presentation of nephrotic syndrome?

Answer 4

Frothy urine
Facial and peripheral oedema
Recurrent infections
Predisposition to VTE

Question 5

What are the primary investigations for nephrotic syndrome?

Answer 5

Urinalysis
24 hour urine protein collection
Urine albumin-creatinine ratio - raised
U&Es
LFTs - hypoalbuminaemia
Lipid profile
Renal ultrasound - exclude structural pathology

Question 6

What is the management of nephrotic syndrome?

Answer 6

Lifestyle modification
- Low salt, protein and fat
- Improve cardiovascular risk factors
Diuretics
ACE inhibitor - used to reduce proteinuria

Question 7

What is the management of focal segmental glomerulosclerosis?

Answer 7

First line - prednisolone
Second line - ciclosporin

Question 8

What is the treatment of membranous nephropathy?

Answer 8

Corticosteroids (prednisolone) combines with an immunosuppressant
- Cyclophosphamide is the first line immunosuppressant

Question 9

What are the complications of nephrotic syndrome?

Answer 9

Hypercholesterolaemia
VTE risk
Infection
Progression to CKD