Nephrotic Syndrome

Question 1

What is the dietary advice for patients with nephrotic syndrome?

Answer 1

No added salt, normal protein with adequate calories

Adequate caloric intake is essential to maintain energy levels.

Question 2

What is the primary treatment for significant edema in nephrotic syndrome?

Answer 2

Diuretics can be used but cautiously

Diuretics should be administered with care to avoid complications.

Question 3

What defines nephrotic range proteinuria?

Answer 3

3+ to 4+ proteinuria on dip sticks, Spot UPC ratio > 2.0mg/mg, UPE > 40 mg/m2/hr in a 24 hr urine collection or ≥ 1000 mg/m2

This indicates a significant loss of protein in the urine.

Question 4

What is the threshold for hypoalbuminemia in nephrotic syndrome?

Answer 4

Less than 3 g/dL (30 g/L)

Hypoalbuminemia is a key feature of nephrotic syndrome.

Question 5

What is a common cause of nephrotic syndrome in children?

Answer 5

Poststrep GN

This condition often has a good prognosis.

Question 6

What are the complications of nephrotic syndrome?

Answer 6

Anasarca, Renal insufficiency, Thromboembolism, Infection, Hypovolemia

Each complication can significantly impact the patient’s health.

Question 7

What is the significance of anasarca in nephrotic syndrome?

Answer 7

Generalized and massive edema associated with complications such as respiratory distress and tissue breakdown

Anasarca can severely limit mobility and respiratory function.

Question 8

What is the typical presentation of nephrotic syndrome during physical examination?

Answer 8

Assessment of hydration status, blood pressure, signs of IgA vasculitis, systemic lupus erythematosus, and abdominal examination

Physical examination aids in identifying fluid imbalances and other systemic signs.

Question 9

What does the presence of active urine sediment indicate?

Answer 9

Glomerular inflammation and likely nephritic disorder

This finding helps differentiate between nephrotic and nephritic syndromes.

Question 10

What is a key laboratory finding in nephrotic syndrome?

Answer 10

Hyperlipidemia

Elevated serum lipids are characteristic of nephrotic syndrome.

Question 11

What does the term ‘steroid-sensitive nephrotic syndrome’ (SSNS) refer to?

Answer 11

Complete remission within 4 weeks of PDN at standard dose

This is an important classification for treatment response.

Question 12

What is a common finding in children with nephrotic syndrome regarding blood count?

Answer 12

Thrombocytosis is common, with platelet counts reaching 500,000 to 1 million counts/microL

This finding is due to the hypercoagulable state associated with nephrotic syndrome.

Question 13

Fill in the blank: The major clinical features of non-inflammatory glomerular lesions are _______ and the nephrotic syndrome.

Answer 13

proteinuria

Non-inflammatory injuries typically do not present with hematuria.

Question 14

What is a potential consequence of hypovolemia in nephrotic syndrome?

Answer 14

Decreased glomerular filtration rate (GFR)

GFR may return to normal after repletion of vascular volume.

Question 15

What are the immune mechanisms of glomerular injury in nephrotic syndrome?

Answer 15

Divided into inflammatory and non-inflammatory mechanisms

Each mechanism leads to different clinical presentations and complications.

Question 16

What does complete remission in nephrotic syndrome require according to the UPCR?

Answer 16

UPCR ≤ 20 mg/mmol or < 100 mg/m2 per day

This criterion is essential for defining treatment success.

Question 17

True or False: Hypertension is common in patients with minimal change disease (MCD).

Answer 17

False

Hypertension is more common in patients with glomerulonephritis.

Question 18

What is the role of antidiuretic hormone (ADH) in nephrotic syndrome?

Answer 18

Decreased free water excretion leading to hyponatremia

ADH release is stimulated by hypovolemia.

Question 19

What is the effect of corticosteroid treatment in nephrotic syndrome?

Answer 19

Mainstay of therapy for nephrotic syndrome

Corticosteroids help induce remission in steroid-sensitive cases.

Question 20

What are the classifications of nephrotic syndrome?

Answer 20

Primary, Secondary, Congenital/Infantile nephrotic syndrome

Each classification has different underlying causes and implications.

Question 21

What are common causes of immune-mediated glomerulonephritis?

Answer 21

IgA nephropathy, lupus nephritis, postinfectious glomerulonephritis

These conditions can lead to nephrotic syndrome.

Question 22

What is nephrotic syndrome characterized by?

Answer 22

Nephrotic range proteinuria, hypoalbuminemia, and edema

These are diagnostic features of nephrotic syndrome.

Question 23

What are common clinical manifestations of nephrotic syndrome?

Answer 23

• Hypertension
• Hematuria
• Signs of hypovolemia
• Tachycardia
• Hypotension
• Peripheral vasoconstriction
• Oliguria
• Decreased glomerular filtration rate (GFR)
• Edema
• Hyperlipidemia

Question 24

True or False: Gross hematuria is common in idiopathic nephrotic syndrome.

Answer 24

False

Gross hematuria is rare in idiopathic nephrotic syndrome.

Question 25

What is the typical presentation of edema in nephrotic syndrome?

Answer 25

* Gravity dependent edema * Marked peripheral edema * Abdominal distension from ascites * Pleural and/or pericardial effusions * Severe periorbital edema

Question 26

How is nephrotic syndrome classified based on relapse frequency?

Answer 26

* Infrequently relapsing Nephrotic Syndrome: < 2 relapses in 6 months * Frequently relapsing Nephrotic Syndrome (FRNS): ≥ 2 relapses in first 6 months * Steroid-dependent nephrotic syndrome (SDNS): 2 consecutive relapses during therapy

Question 27

What factors influence the prognosis of nephritic syndrome?

Answer 27

* Underlying etiology * Age of patients * Timely intervention

Question 28

What are potential complications of nephritic syndrome?

Answer 28

* Acute Kidney Injury * Uncontrolled hypertension * Azotemia * Hyperkalemia * Hyperphosphatemia * Hypocalcemia * Heart failure * Hypertensive encephalopathy

Question 29

What is the primary structural and functional unit of the kidney?

Answer 29

Nephron ## Footnote Nephron consists of a renal corpuscle (glomerulus and Bowman’s capsule) and the renal tubule.

Question 30

What are the main clinical features of glomerulonephritis?

Answer 30

* Hematuria (microscopic or macroscopic) * Hypertension * Acute Kidney Injury (AKI) * Oedema

Question 31

What are the two main classifications of glomerulonephritis?

Answer 31

* Primary GN: isolated to the kidney * Secondary GN: component of a systemic disorder

Question 32

What are the mechanisms of glomerular injury?

Answer 32

* Immune mechanisms * Non-immune mechanisms ## Footnote Immune mechanisms are further divided into inflammatory and non-inflammatory.

Question 33

What is the classic symptom presentation of nephritic syndrome?

Answer 33

* Periorbital and pedal edema * Hematuria with cola-colored urine * Proteinuria (usually non-nephrotic range) * Hypertension * Seizures due to hypertension * Renal insufficiency characterized by oliguria and azotemia

Question 34

What changes occur in the glomerulus during glomerular damage?

Answer 34

* Increased cellularity of the glomerular tuft * Endocapillary and extracapillary proliferation * Formation of crescents in rapidly progressive glomerulonephritis

Question 35

What is the typical urine analysis finding in nephritic syndrome?

Answer 35

Greater than 5 RBCs/HPF along with acanthocytes and dysmorphic RBCs ## Footnote RBC casts and, in some cases, WBC casts may also be present.

Question 36

What is the definition of a relapse in nephrotic syndrome?

Answer 36

Urine dipstick ≥3+ or UPCR ≥ 200 mg/mmol on 3 consecutive days, with or without reappearance of edema in a child who previously achieved complete remission.

Question 37

What management strategies are used for nephrotic syndrome?

Answer 37

* Fluid and dietary salt restriction * Diuretics * Antihypertensives * Corticosteroids * Immunosuppressive drugs * Antibiotics * Dialysis in severe cases

Question 38

What is the role of corticosteroids in nephritic syndrome management?

Answer 38

Help relieve inflammation in the kidney and promote healing, indicated in patients with RPGN.

Question 39

What should be considered when educating parents and teachers about nephrotic syndrome?

Answer 39

* Advice on infection precautions * Danger of sudden steroid withdrawal * Immunization guidelines during corticosteroid treatment

Question 40

What are the signs of fluid overload in a patient with nephrotic syndrome?

Answer 40

* Elevated blood pressure * JVP distention * Pitting edema * Crackles on chest auscultation

Question 41

What is the recommended post-exposure treatment for patients exposed to chickenpox?

Answer 41

Varicella-zoster immunoglobulin (VZIG) should be given within 72 hours after exposure.

Question 42

What are the immunosuppressive therapies used in nephrotic syndrome?

Answer 42

* Steroids * Levamisole * Cyclosporin * Tacrolimus * Mycophenolate mofetil * Cyclophosphamide * Rituximab