Nephrotic Syndrome Flashcards
What is nephrotic syndrome. (3)
It is a triad of:
Proteinuria >3.5.
Hypoalbuminaemia.
Oedema.
What is often present in nephrotic syndrome.
Severe hyperlipidaemia.
What is the cause of nephrotic syndrome.
Nephrotic syndrome is not a diagnosis, so the underlying cause should always be sought.
What are some primary causes of nephrotic syndrome. (4)
Minimal change disease.
Membranous nephropathy.
Focal segmental glomerulosclerosis (FSGS).
Mesangiocapillary GN.
What are some secondary causses of nephrotic syndrome. (6)
Hepatitis B/C. SLE. Diabetic nephropathy. Amyloidosis. Paraneoplastic. Drug related (NSAIDs, anti-TNF, gold).
What is the mechanism of nephrotic syndrome.
Injury to the podocyte appears to be the main cause of proteinuria.
What arre podocytes.
They wrap around the glomerular capillaries and maintain the filtration barrier, preventing large molecular weight proteins from entering the urine.
Damage can therefore cause heavy protein loss.
What is the primary cause of presentation of patients with nephrotic syndrome. (2)
Pitting oedema, which can be severe and rapid onset.
It occurs in dependent areas and areas of low tissue resistance (eg periorbitally).
What aspects of the history are important in a patient presenting with nephrotic syndrome. (4)
Acute or chronic infections.
Drugs.
Allergies.
Systemic symptoms suggestive of autoimmunity or malignancy.
What are the signs of nephrotic syndrome. (4)
Urine usually shows high protein.
Low albumin.
BP is normal or slightly high.
Renal function is usually normal or slightly impaired.
What is the differential diagnosis for patients presenting with nephrotic syndrome. (2)
CCF (raised JVP, pulmonary oedema, mild proteinuria). Liver disease (low albumin).
What should occur in all adults presenting with nephrotic syndrome.
Renal biopsy.
What is the commonest cause of nephrotic syndrome in children
Minimal change in GN.
Is renal biopsy done in children.
Avoided unless they are unresponsive to steroid trial or clinical features suggest another cause.
What treatment is given to children with nephrotic syndrome.
Steroid trial causes resolution in 90%.
