Nephrotic syndrome Flashcards
What is nephrotic syndrome?
Nephrotic syndrome is a clinical complex characterised by a triad of proteinuria (> 3g/24hr), hypoalbuminaemia (< 30g/L), and oedema.
What are the primary causes of nephrotic syndrome?
Primary causes include minimal change disease, focal segmental glomerulosclerosis (FSGS), and membranous nephropathy.
What are the secondary causes of nephrotic syndrome?
Secondary causes include diabetes mellitus, systemic lupus erythematosus (SLE), amyloidosis, infections (HIV, hepatitis B and C), and drugs (NSAIDs, gold therapy).
What is the pathophysiology of nephrotic syndrome?
The underlying mechanism involves damage to the glomerular basement membrane and podocytes, leading to increased permeability to proteins.
What are the consequences of proteinuria in nephrotic syndrome?
Proteinuria results in hypoalbuminaemia and subsequent oedema due to reduced plasma oncotic pressure.
What predisposes patients with nephrotic syndrome to thrombosis?
Loss of antithrombin-III, proteins C and S, and an associated rise in fibrinogen levels predispose to thrombosis.
How does nephrotic syndrome affect thyroxine levels?
Loss of thyroxine-binding globulin lowers the total, but not free, thyroxine levels.
What initial investigations are performed for nephrotic syndrome?
Initial investigations include urine dipstick for proteinuria, MSU to exclude urinary tract infection, quantifying proteinuria, FBC and coagulation screen, and urea and electrolytes.
Diagram showing the glomerulonephritides and how they typically present
What is a complication of nephrotic syndrome related to thromboembolism?
Increased risk of thromboembolism due to loss of antithrombin III and plasminogen in the urine.
What types of thromboembolism are associated with nephrotic syndrome?
Deep vein thrombosis and pulmonary embolism.
What renal complication can occur in nephrotic syndrome?
Renal vein thrombosis, resulting in a sudden deterioration in renal function.
What metabolic complication is associated with nephrotic syndrome?
Hyperlipidaemia.
What cardiovascular risks are increased due to nephrotic syndrome?
Increased risk of acute coronary syndrome and stroke.
What long-term kidney condition can result from nephrotic syndrome?
Chronic kidney disease.
What infection risk is heightened in nephrotic syndrome?
Increased risk of infection due to urinary immunoglobulin loss.
What mineral deficiency can occur in nephrotic syndrome?
Hypocalcaemia due to loss of vitamin D and binding protein in urine.
Risk factors diabetic nephropathy
