Nephrotic Syndrome Flashcards
What is nephrotic syndrome?
Nephrotic syndrome is a clinical condition characterized by significant proteinuria (≥3.5 g/day), hypoalbuminaemia (serum albumin ≤30 g/L), and oedema. It results from increased permeability of the glomerular filtration barrier.
What are the primary causes of nephrotic syndrome?
Primary causes include diseases that directly affect the kidneys, such as minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy.
What are the secondary causes of nephrotic syndrome?
Secondary causes involve systemic diseases or factors affecting the kidneys, including diabetes mellitus, systemic lupus erythematosus, infections (e.g., hepatitis B, hepatitis C), certain medications (e.g., NSAIDs), and malignancies.
What are the common symptoms of nephrotic syndrome?
Symptoms include peripheral oedema (more common in adults), facial oedema (more common in children), frothy urine, fatigue, poor appetite, and increased susceptibility to infections.
What is the pathophysiology of nephrotic syndrome?
Damage to the glomerular filtration barrier leads to increased permeability, resulting in significant protein loss in urine (proteinuria). This causes hypoalbuminaemia, reducing plasma oncotic pressure and leading to oedema. The liver compensates by increasing lipoprotein synthesis, causing hyperlipidaemia.
What are the complications associated with nephrotic syndrome?
Complications can include thromboembolism due to hypercoagulability, increased risk of infections, acute kidney injury, and cardiovascular disease related to hyperlipidaemia.
How is nephrotic syndrome diagnosed?
Diagnosis is based on clinical presentation and laboratory findings, including significant proteinuria (≥3.5 g/day), hypoalbuminaemia (serum albumin ≤30 g/L), and hyperlipidaemia. A renal biopsy may be performed to determine the underlying cause, especially in adults.
What laboratory tests are important in nephrotic syndrome?
Important tests include urinalysis (to detect proteinuria), serum albumin levels, lipid profile (to assess hyperlipidaemia), renal function tests (e.g., serum creatinine, eGFR), and coagulation profile.
What imaging studies might be considered in nephrotic syndrome?
Imaging is not typically required for diagnosis but may be used to assess complications or underlying causes. Renal ultrasound can evaluate kidney size and structure, and Doppler studies can assess renal vein thrombosis if suspected.
What is the primary treatment for nephrotic syndrome?
Treatment focuses on addressing the underlying cause, managing symptoms, and preventing complications. This includes the use of corticosteroids or other immunosuppressive agents for certain primary causes, along with supportive measures such as diuretics for oedema, ACE inhibitors or ARBs to reduce proteinuria, and statins for hyperlipidaemia.
How is oedema managed in nephrotic syndrome?
Oedema is managed with salt restriction, fluid management, and diuretics such as loop diuretics. In severe cases, intravenous albumin infusion may be considered.
What role do ACE inhibitors or ARBs play in nephrotic syndrome management?
ACE inhibitors or ARBs reduce proteinuria and help control blood pressure, thereby slowing the progression of kidney damage.
How is hyperlipidaemia managed in nephrotic syndrome?
Hyperlipidaemia is managed with dietary modifications and lipid-lowering agents such as statins to reduce cardiovascular risk.
What vaccinations are recommended for patients with nephrotic syndrome?
Patients are advised to receive vaccinations against pneumococcus and influenza to reduce the risk of infections, especially if they are receiving immunosuppressive therapy.
Why are patients with nephrotic syndrome at increased risk of infections?
Loss of immunoglobulins in urine and the use of immunosuppressive therapies contribute to an increased susceptibility to infections.
