Nephrotic syndrome Flashcards
what is it a triad of
proteinuria (>3.5g/24 hour), hypoalbuminaemia (<25g/L), oedema
what can cause nephrotic syndrome (primary)
minimal change disease; membranous nephropathy; focal segmental glomerulosclerosis, mesangiocapillary GN
what are the secondary causes of nephrotic syndrome
hep B/C; SLE; diabetic nephropathy; amyloidosis; drug related
what is the pathophysiology
injury to the podocyte which causes heavy protein loss
what can patients present with
pitting oedema
signs
urine dip shows ++++ protein, low albumin, bp normal or slightly high, renal function usually normal or mildly impaired
differential diagnosis
CCF (incr JVP, pulm oedema, mild proteinuria) or liver disease (decr albumin)
what is the most common cause in children
minimal change disease (lesion in the glomerulus) steroids used
when is biopsy requires in children
if no response to steroids or signs point to another cause- age <1 year, family history, extra renal disease, renal failure, haematuria
why is renal biopsy more difficult in patients with nephrotic syndrome
because of gross oedema and a hypercoagulable state
complications
susceptibility to infection- cellulitis, strep, spont bacterial peritonitis (as Ig lost in urine and immunosuppressants); thromboembolism (incr clotting factors and platelet abnormalities); hyperlipidaemia ( incr chol and triglycerides)
treatment to reduce oedema
loop diuretics- furosemide. fluid restriction to 1L/day and salt restrict whilst on diuretics
treatment
reduce oedema, reduce proteinuria, reduce risk of complications, treat underlying cause
treatment to reduce proteinuria
ACEi or ARB
treatment to reduce risk of complications
anticoagulate if nephrotic range proteinuria, start statin to reduce chol, treat infections and vaccinate
what % of nephrotic adults have minimal change disease
20%
what can minimal change disease be due to in adults
idiopathic, in association with NSAIDS, or paraneoplastic
if freq relapse minimal change disease what is the treatment
cyclophosphamide or ciclosporin/tacrolimus
what accounts for 20-30% of nephrotic syndrome in adults
membranous nephropathy (2-5% in children)
what can cause membranous nephropathy
mostly idiopathic, can be assoc with malignancy, NSAIDS, hep B, drugs (gold, penicillamine, NSAIDs), and autoimmunity (thyroid, SLE).
what does biopsy show in membranous nephropathy
diffusely thickened GBM with IgG and C3 subepithelial deposits on IF
treatment membranous nephropathy
underlying cause. ACE/ARB and diuretics.
what is mesangiocapillary GN
mesangial and endocapillary proliferation a thickened capillary basement membrane
treatment mesangiocapillary GN
underlying cause, ACE/ARB, immunosuppression with steroids and cyclophosphamide. poor prognosis
