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Pediatrics I - OSCE > Nephrotic Syndrome > Flashcards

Nephrotic Syndrome Flashcards

1
Q
A
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2
Q

Def of Nephrotic Syndrome

A
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3
Q

Incidence of Idiopathic Nephrotic Syndrome

A
  • It is the most common form of childhood NS.
  • Representing more than 90 percent of cases between 1 and 10 years of age and 50 percent after 10 years of age.
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4
Q

Age in Idiopathic Nephrotic Syndrome

A

2:8 years

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5
Q

Sex in Idiopathic Nephrotic Syndrome

A

Male 2 : Female 1

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6
Q

Pathogenesis of Idiopathic Nephrotic Syndrome

  • Mechanism of Glomerular Injury
A
  • Circulating non-immune Factors
  • Circulating immune Factors
  • Mutations in podocyte or slit diaphragm proteins
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7
Q

Mechanism of Glomerular Injury in Nephrotic Syndrome

  • Circulating non-immune factors:
A
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8
Q

Mechanism of Glomerular Injury in Nephrotic Syndrome

  • Circulating immune factors:
A
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9
Q

Mechanism of Glomerular Injury in Nephrotic Syndrome

  • Mutations in podocyte or slit diaphragm proteins
A
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10
Q

Pathogenesis of Idiopathic Nephrotic Syndrome

  • Mechanism of Edema
A
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11
Q

Mechanism of Edema in Nephrotic Syndrome

  • Arterial Underfiling
A
  • A reduction in plasma oncotic pressure induced by hypoalbuminemia would seem to favor the movement of fluid out of the vascular space into the interstitium and produce arterial underfilling.
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12
Q

Mechanism of Edema in Nephrotic Syndrome

  • Sodium retention
A
  • Sodium retention is due to increased reabsorption in the collecting tubules mainly due to increased activity of the Na-K-ATPase pump in the cortical collecting tubule and relative resistance to atrial natriuretic peptide.
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13
Q

Pathogenesis of Nephrotic Syndrome

  • Mechanism of hypoalbuminemia
A
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14
Q

Pathogenesis of Nephrotic Syndrome

  • Mechanism of Proteinurea
A
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15
Q

Pathogenesis of Idiopathic Nephrotic Syndrome

  • Mechanism of Hyperlipidemia
A
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16
Q

CP of Nephrotic Syndrome

A
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17
Q

CP of Nephrotic Syndrome

  • Edema
A
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18
Q

What is the major Presenting Symptom of Nephrotic Syndrome?

A

Edema

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19
Q

Edema in Nephrotic Syndrome

  • Manifestation
A

It becomes clinically detectable when fluid retention exceeds 3-5% of body weight.

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20
Q

Edema in Nephrotic Syndrome

  • Sites
A
  • Periorbital edema frequently misdiagnosed as allergy is often the initial symptom.
  • Edema is gravity dependent, localized to the lower extremities in the upright position, and to the dorsal part of the body in reclining position.
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21
Q

Edema in Nephrotic Syndrome

  • Characters
A
  • This edema is soft and pitting, keeping the marks of clothes or finger pressure.
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22
Q

Edema in Nephrotic Syndrome

  • Severity
A
  • Anasarca may develop with ascites, and pleural and pericardial effusions. (If anasarca occurred can’t be AGN)
  • Edema of the scrotum and penis, or labia, may be seen.
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23
Q

CP of Nephrotic Syndrome

  • Abdominal Pain
A
  • It may be related to rapid formation of ascites or concomitant hypovolemia.
  • It is occasionally due to a complication such as peritonitis, thrombosis or rarely, pancreatitis.
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24
Q

CP of Nephrotic Syndrome

  • HTN
A
  • Mild in 95% of cases.
  • Blood pressure is usually normal but sometimes elevated.
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25
Q

CP of Nephrotic Syndrome

  • Macroscopic Hematuria
A

It is observed in 3% of cases.

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26
Q

CP of Nephrotic Syndrome

  • Complications
A

The disease may also be revealed by a complication

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27
Q

CP of Nephrotic Syndrome

  • Asymptomatic
A

NS is occasionally discovered during a routine urine analysis.

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28
Q

Urine Analysis in Nephrotic Syndrome

  • Volume
  • Color
  • Casts
  • Specific Gravity
A
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29
Q

Investigations for Nephrotic Syndrome

  • Urine Analysis
A
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30
Q

Investigations for Nephrotic Syndrome

A
  • Urine & Blood
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31
Q

Urine Analysis in Nephrotic Syndrome

  • Proteinuria
A
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32
Q

Qualitative Evaluation of Proteinuria in Nehrotic Syndrome

33
Q

Quantitative Evaluation of Proteinuria in Nehrotic Syndrome

34
Q

What is the screening test for Proteinuria in Nephrotic Syndrome?

A

Using urine dipstick

35
Q

Urine Analysis in Nephrotic Syndrome

  • Urine Protein Selectivity
36
Q

Investigations for Nephrotic Syndrome

  • Blood Tests
37
Q

What is the Confirmatory test for Proteinuria in Nephrotic Syndrome?

A
  • Using 24-hour urine protein
  • Using Spot urine protein / creatinine ratio
38
Q

Blood Tests for Nephrotic Syndrome

  • CBC
  • PTN
  • Lipids
  • C3
  • Ck
39
Q

Pathological Dx of Nephrotic Syndrome

40
Q

When is Renal Bx Indicated in children in Nephrotic Syndrome?

41
Q

Complications of Nephrotic Syndrome

A
  • Infections
  • Thromboembolism
  • Hypovolemia
  • Renal Insufficiency
  • Corticosteroids SE
42
Q

Most Common Complications of Nephrotic Syndrome

A

Infections

43
Q

Bacterial Infections in Nephrotic Syndrome

  • most Common Site
A
  • The most common infection is peritonitis.
  • Patients may also develop meningitis, pneumonia, UTI and cellulitis.
44
Q

Bacterial Infections in Nephrotic Syndrome

  • Organism
A
  • Streptococcus pneumoniae “most common”
  • Others: E. coli, streptococcus B, Haemophilus influenzae & other G-ve organisms
45
Q

Complications in Nephrotic Syndrome

  • Thromboembolism
46
Q

Most Dangerous Complication in Nephrotic Syndrome

A

Thromboembolism

47
Q

Thromboembolism in Nephrotic Syndrome

  • Sites
A
  • Both arterial and venous thromboses have been reported.
  • Most common: pulmonary artery, renal vein, deep leg veins, inferior vena cava, and femoral/iliac artery.
  • Others: cerebral and meningeal arteries, mesenteric and hepatic veins.
48
Q

Complications in Nephrotic Syndrome

  • Renal Insufficiency
49
Q

TTT Aspects of Nephrotic Syndrome

A
  • General
  • Specific
50
Q

General TTT of Nephrotic Syndrome

  • Diet
51
Q

General TTT of Nephrotic Syndrome

  • Bed Rest
A

Noooo “cause thrombosis”

52
Q

General TTT of Nephrotic Syndrome

  • Edema
53
Q

General TTT of Nephrotic Syndrome

  • Hypovolemia
54
Q

General TTT of Nephrotic Syndrome

  • Prevention of Complications
55
Q

Prevention of Complications in Nephrotic Syndrome

  • Infections
A
  • S pneumonia: Oral penicillin + Pneumococcal vaccine
  • Varicella: Acyclovir + Varicella vaccine
56
Q

Prevention of Complications in Nephrotic Syndrome

  • Thromboembolism
57
Q

Prevention of Complications in Nephrotic Syndrome

  • Hyperlipidemia
A

It is reasonable to consider a lipid lowering regimen in children with a persistent NS

58
Q

Specific TTT of Nephrotic Syndrome

  • DOC
A
  • Oral steroids: Corner stone
  • The commonly used preparation is prednisone.
59
Q

Specific TTT of Nephrotic Syndrome

  • TTT of First Episode
60
Q

Indications of Empiric TTT of Nephrotic Syndrome with Corticosteroids

61
Q

TTT of First Episode in Nephrotic Syndrome

  • Monitoring
A

Once a patient responds to steroid therapy, monitoring for proteinuria is required to detect relapses early.

62
Q

Def of Relapse in Nephrotic Syndrome

A

Appearance of significant proteinuria (>40 mg/h/ m2 or >50 mg/kg/day or Albustix +++) for 3 consecutive days after having been in remission.

63
Q

Patients who respond to steroid have one of the following courses:

64
Q

Treatment of frequent relapsing/ steroid dependent NS:

65
Q

Treatment of steroid resistant NS (SRNS)

  • Due to Genetic Disorder
66
Q

Treatment of steroid resistant NS (SRNS)

  • Not Due to Gentic Disorder
A
  • ACEI and ARB are used.
  • Immunosuppressive therapy depends on the underlying pathology.
67
Q

What are Examples of Steroid Sparing Agents?

A
  • Levamisole
  • Cyclophosphamide
  • Cyclosporine
  • Myco-phenolate mofetil
68
Q

Compare between Nephrotic & Nephritic Syndrome in terms of

  • Strept inf
69
Q

Compare between Nephrotic & Nephritic Syndrome in terms of

  • Edema
70
Q

Compare between Nephrotic & Nephritic Syndrome in terms of

  • Oliguria
71
Q

Compare between Nephrotic & Nephritic Syndrome in terms of

  • HTN
72
Q

Compare between Nephrotic & Nephritic Syndrome in terms of

  • Hematuria
73
Q

Compare between Nephrotic & Nephritic Syndrome in terms of

  • Serum Albumin
74
Q

Compare between Nephrotic & Nephritic Syndrome in terms of

  • Serum Cholesterol
75
Q

Compare between Nephrotic & Nephritic Syndrome in terms of

  • C3 & C4
76
Q

Compare between Nephrotic & Nephritic Syndrome in terms of

  • ASO
77
Q

Compare between Nephrotic & Nephritic Syndrome in terms of

  • Proyeinuria
78
Q

Compare between Nephrotic & Nephritic Syndrome in terms of

  • Casts

Pediatrics I - OSCE (20 decks)

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