Nephrotic Syndrome

Question 1

What is the nephrotic syndrome?

Answer 1

• Nephrotic syndrome is a symptom cluster used to narrow down causes of glomerular renal disease
• Presence of
  • Proteinuria (>3.5 g in 24 hours)
  • Hypoalbuminaemia (<30 g/L)
  • Oedema
  • Hyperlipidaemia

Question 2

Describe the pathogenesis of the nephrotic syndrome

Answer 2

• Underlying disease
• Glomerular proteinuria caused by disruption to the components of the glomerular membrane
  
  • Fenestrated capillary endothelium
  • Basement membrane
  • Podocyte foot processes
  • Slit diaphragms (nephrin)
• Liver function increases to attempt albumin compensation leading to lipid abnormalities, hypercoagulability
• Oedema results from decrease in oncotic pressure to due hypoalbuminaemia

Question 3

What is the most common cause of the nephrotic syndrome in adults? In children?

Answer 3

• Focal segmental glomerulosclerosis (due to HIV, reflux, obesity)
• Minimal change disease

Question 4

What are the common symptoms and signs on presentation for a person with nephrotic syndrome?

Answer 4

• Diabetes, malignancy, SLE, HIV, MM, amyloidosis history
• Previous renal disease
• Foamy urine
• Oedema/anasarca
  
  • Can involve face
• White banding of nails
• Xanthelasmata