Nephrotic syndrome

Question 1

What are the complications nephrotic syndrome?

Answer 1

1) Increased susceptibility to INFECTIONS - 20%
- Cellulitis, bacterial peritonitis, Strep infections
- Reduced serum IgG, reduced complement activity, reduced T Cell function (Loss of immunoglobulin in urine and immonsuppressive treatments)

2) Thromboembolism - 40%
- DVT / PE, renal vein thrombosis.
- Hypercoagulable state due to increased clotting factors and platelet abnormalities

3) Hyperlipidaemia - Hepatic lipoprotein synthesis due to hypoalbuminaemia state (low oncotic pressure) leads to high serum triglycerides and cholesterol

Question 2

How do you treat a nephrotic syndrome?

Answer 2

1) Reduce oedema - loop diuretics, daily weights, fluid restrict
2) Reduce proteinuria - ACE-i, ARBs
3) Reduce risk of complications - Anticoagulate if nephrotic range proteinuria, Statin, treat infections promptly, vaccinate
4) Treat underlying cause - infections, malignancy or systemic disease. Stop causative drugs. Some primary causes don’t respond to drugs.

Question 3

Who get a biopsy?

Answer 3

Children generally don’t, unless not responding to steroids or clinical features suggest another cause.

All adults should get a biopsy and full assessment.
NB oedema and hyper coagulability can make this more difficult.

Question 4

What are some of the primary causes of nephrotic syndrome?

Answer 4

• Minimal change disease
• Focal segmental glomerularsclerosis
• Membranous GN

Question 5

What are some of the secondary causes of nephrotic syndrome?

Answer 5

• Hep B/C - usually membranous
• SLE - membranous
• diabetic nephropathy
• amyloidosis
• paraneoplastic - usually membranous
• Drug - NSAIDs, penicillamine, gold, anti-TNF

Question 6

What is the classic triad of nephrotic syndrome?

Answer 6

• Proteinuria >3,5g/24hr
• hypoalbuminaemia
• oedema

also hyerlipidaemia