Nephrotic Syndrome

Question 1

What is nephrotic syndrome?

Answer 1

clinical syndrome affecting the kidney, characterised by significant proteinuria, peripheral oedema, hypoalbuminemia and hyperlipidemia

Question 2

Epidemiology of nephrotic syndrome?

Answer 2

2-6y

M more than female

Question 3

What are the causes of primary nephrotic syndrome in kids withOUT glomerular inflammation?

Answer 3

Glomerular inflamation ABSENT:

• Minimal change disease
• FSGS

Question 4

What are the causes of primary nephrotic syndrome with glomerular inflammation?

Answer 4

• Membranoproliferative glomerulonephritis

- IgA nephropathy

Question 5

Hx / PEx features of nephrotic syndrome?

Answer 5

• Non specific (irritability, malaise, diarrhoea)
• Oedema
• Decrease in circulating volume (tachycardia, HTN, oliguria)
• Foamy urine (proteinuria)

Question 6

Urine Ix in ?nephrotic syndrome?

Answer 6

• dipstick (protein)

- microscopy (oval fat bodies, hyaline casts)

Question 7

Blood ix in ?nephrotic syndrome?

Answer 7

Diagnostic:
-Hypoalbuminemia
-Hyperlipidemia / hypercholesterolemia
Secondary:
-UEC (hypoCa, hyperK, hypoNa; Cr inc)
-Coag (dec PTT)
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R/o other causes:
-FBE
-Blood smear
-C3/4, ANA
-HBV/HCV
HIV serology

Question 8

Mx MCD?

Answer 8

• Oral Pred for up to 12w (2mg/kg)
• Symptomatic Mx
• Daily weights and BP

Question 9

Prognosis paediatric nephrotic syndrome?

Answer 9

Good- 80% respond to CSTs. Up to 2/3 may relapse. Usually sustained remission by adolescence.

Question 10

Complications nephrotic syndrome?

Answer 10

• Inc risk of infections (peritonitis, cellulitis, sepsis)

- Hypercoaguability (due to dec volume and ATIII depletion)