Nephrotic Syndrome (2)

Question 1

What occurs here?

What is the most common cause of it in children?

What is the most common cause of it in adults?

What are other causes?

Answer 1

➊ Glomerular basement membrane becomes very leaky to proteins

➋ Minimal Change Disease

➌ Membranous Glomerulonephritis

➍ • Intrinsic Kidney Disease - Focal segmental glomerulosclerosis, Membranoproliferative glomerulonephritis
• Systemic diseases – SLE, Henoch Schoenlein purpura (HSP), Diabetes
• Infections - HIV, Hepatitis, Malaria, Syphilis
• Drugs – NSAIDs, Heroin

Question 2

What are the main presenting features?

Why does Hyperlipidaemia occur here?

Answer 2

➊ • Frothy urine – Due to the Proteinuria
• Oedema – Periorbital first, followed by peripheral oedema, ascites and perineal oedema
• Hypoalbuminaemia
• Hyperlipidaemia
• Hypercoagulability
• HTN

➋ The low albumin causes a low oncotic pressure. In order to maintain a normal pressure, the liver compensates by increasing synthesis of lipoproteins.

Question 3

What are the investigations to do? What result do you expect?

Answer 3

• Urine dip – Proteinuria (> 3g/24hrs)
• Urinalysis – Raised ACR
• Renal biopsy

Question 4

Management:
What is the mainstay of treatment?
→ What can be given if steroid-resistant?

What else may be done?

Answer 4

➊ High-dose steroids – Most respond really well within 4 wks, after which they’re weaned off it
→ Immunosuppressants

➋ • Low salt diet
• Diuretics if severely oedematous
• Albumin infusion in cases of severe Hypoalbuminaemia