Nephrotic Syndrome

Question 1

What is the most common cause of nephrotic syndrome?

Answer 1

Membranous nephropathy in older people

Question 2

What will biopsy show in membranous nephropahty?

Answer 2

Thickening of the glomerular basement membrane without cellular proliferation with spike and dome

Question 3

What causes subepithelial immune complex deposition?

Answer 3

Lupus nephritis

Question 4

Which medications can cause nephrotic syndrome?

Answer 4

->Bisphosphonates
-> NSAIDs
-> D-penicillamine for hereditary haemochromatosis
-> Probenecid
Tolbutamide

Question 5

What are Muehrcke’s lines?

Answer 5

Paired white transverse lines across the nails that may occur secondary to hypoalbuminemia

Question 6

What is the first line for nephrotic syndrome?

Answer 6

Corticosteroids

Question 7

Which common chronic condition is a risk factor?

Answer 7

Diabetic nephropathy

Question 8

What does nephrotic syndrome increase the risk of in the lungs?

Answer 8

Development of pleural effusion, characterised by acute dyspnoea and reduced air entry at lung bases with dullness to percussion

Question 10

What is the testing for membranous nephropathy?

Answer 10

Antiphospohlipaise A2 receptor

-> most common cause of nephrotic syndrome in Caucasian adults

Question 11

What are the biopsy findings for membranous nephropathy?

Answer 11

Subepithelial immune complex deposits

Question 12

What is minimal change disease associated with?

Answer 12

Lymphoma or NSAID use

Question 13

What is focal segmental glomerulosclerosis associated with?

Answer 13

Drug use
Chronic viral infection like HIV
Lithium
Afro-Carribean population

Question 14

What is the biopsy finding for focal segmental glomerulosclerosis?

Answer 14

Sclerosis of SEGMENTS of glomerular tuft

Question 15

What is the cause of spike and dome appearance on biopsy?

Answer 15

Membranous nephropathy

Question 16

Which nephrotic syndrome is associated with hepatitis C?

Answer 16

Membranoproliferative glomerulonephritis
-> it can be idiopathic or related to systemic upus

Question 17

When is biospy indicated in children?

Answer 17

Only if they are not responding to steroids because this indicates it may not be minimal change disease

Question 18

Prophylaxis for nephrotic syndrome?

Answer 18

Prophylactic anticoagulation due to risk of thromboembolism

Question 19

Which type of nephrotic syndrome has a high risk of progression to end stage renal failure?

Answer 19

Focal segmental glomerulosclerosis

Question 20

What is first line for minima change disease?

Answer 20

Steroids

Question 21

What is second line for minimal change disease?

Answer 21

Immunosuppressant lie ciclosporin

Question 22

What is the prognosis of minimal change disease?

Answer 22

1.3 of patients dependent on continued steroid or immunosuppression therapy

Question 23

Which condition is present in both nephritic and nephrotic syndrome?

Answer 23

Membranous glomerulonephritis

Question 24

What causes tram track appearance on biopsy?

Answer 24

Membrnaoproliferative glomeurlonephiritis, associated with hepatitis B or C and cryoglobulinaemia

Question 25

What is the cause of IgG deposition in mesangium?

Answer 25

Post-streptococcal glomerulonephritis, a nephritic syndrome

Question 26

What is a common cause of nephrotic syndrome in sickle cell disease?

Answer 26

Focal segmental glomerulosclerosis Cyclosophamide should be used with steroids for treatment

Question 27

What test other than urine dip is important for onfirming minimal change disease?

Answer 27

Serum albumin

Question 28

How does membranous nephropathy present?

Answer 28

Gradual feline in renal function with proteinuria and oedema

Question 29

What is the renal screen?

Answer 29

Protein electrophoresis, C3, C4, ANA, dsDNA, ANCA, anti-GBM, immunoglobulins