Nephrotic Syndrome

Question 1

What is Nephrotic syndrome characterized by?

Answer 1

• > 3.5 g proteinuria/day which causes
• hypoalbuminaemia (usually <2.5g/dl or 25g/l) because albumin is usually the most abundant protein in the blood
• Oedema from salt and water retention (including periorbital oedema)
• +/_ dyslipidaemia
• +/- Lipiduria

Question 2

What is the Epidemiology of nephrotic syndrome?

Answer 2

The incidence of nephrotic syndrome worldwide has been estimated to be about 3 new cases per 100,000 per year.

Incidence /prevalence of adult nephrotic syndrome in Nigeria is unknown as there is no registry data available, but nephrotic syndrome is not an uncommon disease in Nigerian adult population.

Question 3

Specific investigations in NS

Answer 3

Hepatitis B & C, HIV
Filariasis
Tests for Conn Tiss Dx
Tests when clinically relevant e.g:
For vasculitis (ANCA)
For PSGN (rare in adults)

Question 4

Tests are done to exclude what?

Answer 4

Tests to Exclude
Diabetes – diagnosis
Myeloma
Lymphoma
Cancers

Question 5

Other investigations in NS
Which investigation would not be helpful?
What does a CT scan exclude?

Answer 5

1. Imaging
   * X-ray chest
   * CT scan e.g. to exclude lymphoma etc. (EUG, Ultrasound NOT helpful)
2. Renal Biopsy

Question 6

Indications for renal biopsy

Answer 6

Persistent Proteinuria
Persistent Macroscopic haematuria (of glomerular aetiology)
Nephrotic syndrome
Unexplained:
-ARF
-CRF (with normal sized kidneys)
Allograft dysfunction

Question 7

General management measures of NS

Answer 7

General measures
Dietary sodium restriction
Diuretics
-Nephrotic patients may malabsorb diuretics (as well as other drugs) due to gut mucosal oedema
Normal protein diet is advisable. A high-protein diet increases proteinuria and can be harmful in the long term, whereas a low-protein diet can lead to malnutrition.
Albumin infusion produces only a transient effect. It is only given to patients who are diuretic-resistant
Anticoagulation

Antibiotics if Sepsis.
Statins
ACE inhibitors and/or angiotensin II receptor antagonists

Question 8

Specific management measure of NS

Answer 8

Treat the underlying cause

Question 9

Primary causes of nephrotic syndrome

Answer 9

1. Minimal-change nephropathy; most common is children
2. Congenital nephrotic syndrome
3. Focal (some glomeruli) segmental (parts of individual glomuerulus) glomerular sclerosis: scarring of the glomeruli
4. Membranous nephropathy: thickening of basement membrane

Question 10

Secondary causes of nephrotic syndrome

Answer 10

Amyloidosis: deposition and accumulation of amyloid in tissues
Diabetic nephropathy