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4 Finals > Nephrotic syndrome > Flashcards

Nephrotic syndrome Flashcards

1
Q

What is nephrotic syndrome?

A

Presence of proteinuria (>3.5g/24h)
Hypoalbuminaemia (<30g/L)
Peripheral oedema

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2
Q

What other 2 features are commonly seen in nephrotic syndrome other than the diagnostic features?

A

Hyperlipidaemia

Thrombotic disease

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3
Q

What is nephritic syndrome?

A

Presence of AKI
HTN
Active urinary sediment (red cells and red cell casts)

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4
Q

Does the urine in nephrotic syndrome contain casts?

A

Very few.

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5
Q

If a patient presents with isolated heavy proteinuria but no other features of nephrotic syndrome, what can this be called?

A

Nephrotic-range proteinuria

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6
Q

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

A

Minimal change disease

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7
Q

What is the most common cause of nephrotic syndrome in adult males?

A

Primary glomerular diseases

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8
Q

What is the most common cause of nephrotic syndrome in adult females?

A

Secondary glomerular disease

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9
Q

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

A

FSGS (focal segmental glomerulosclerosis)

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10
Q

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

A

Membranous nephropathy

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11
Q

What is the most common cause of nephrotic syndrome in diabetics?

A

Diabetic nephropathy

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12
Q

Is nephrotic or nephritic syndrome more common in pts with IgA nephropathy, membranoproliferative glomerulonephritis, and post-infectious glomerulonephritis?

A

Nephritic

but both possible

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13
Q

When can minimal change disease occur in adults?

A

Idiopathic
Relation to NSAID use
Hodgkin’s lymphoma

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14
Q

Why is it called minimal change disease?

A

Light microscopy finds normal glomeruli or mild mesangial proliferation

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15
Q

What does electron microscopy show in minimal change disease?

A

Diffuse effacement of the epithelial cell foot processes

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16
Q

What does immunofluorescence show in minimal change disease?

A

No immune complex deposition

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17
Q

How is minimal change disease treated?

A

Steroids

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18
Q

What does light microscopy show in FSGS?

A

Segmental areas of mesangial collapse and sclerosis affecting some but not all glomeruli

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19
Q

What causes primary FSGS?

A

Idiopathic - unknown

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20
Q

What can cause secondary FSGS?

A

HIV
Obesity
Reflux nephropathy

21
Q

How is primary FSGS treated?

A

Immunospression

22
Q

How is secondary FSGS treated?

A

Reducing intraglomerular pressure (renin-angiotensin blockade)

23
Q

How does FSGS commonly present?

A

Haematuria
HTN
Reduced renal function

24
Q

How is FSGS diagnosed?

A

Renal biopsy

25
Q

What does light microscopy show in membranous nephropathy?

A

basement membrane thickening without assoc. cellular proliferation or infiltration

26
Q

What does immunofluoresence show in membranous nephropathy?

A

Diffuse, granular IgG deposition throughout the capillary walls

27
Q

What does electron microscopy show in membranous nephropathy?

A

Electron-dense deposits in the subepithelial space

New basement membrane growth between subepithelial immune deposits leads to the classic ‘spike and dome’ appearance

28
Q

Membranous nephropathy is usually idiopathic, but what may it be due to?

A

Hep B
AI disease
Malignancy
Adverse drug reactions

29
Q

How does diabetic nephropathy usually present?

A

Microalbuminuria

Prgrssive fall in eGFR

30
Q

How does diabetic nephropathy present in microscopy?

A

Mesangial expansion, glomerular basement membrane thickening, and glomerular sclerosis leading to the development of Kimmelstiel-Wilson nodules

31
Q

Amyloidosis is responsible for what % of nephrotic syndrome cases?

A

~10%

32
Q

How is Amyloidosis investigated?

A

Presence of a monoclonal paraprotein in urine or plasma

33
Q

What is the primary insult leading to the development of nephrotic syndrome?

A

High-grade glomerular proteinuria

- heavier protein loss the more likely the development of the full-blown syndrome

34
Q

Why do patients become hypoalbuminaemic in nephrotic syndrome?

A

Albumin is lost in urine

35
Q

What does the liver do in hypoalbuminaemia?

A

Synthesises albumin, LDL, VLDL, and lipoprotein

36
Q

How does lipiduria appear in nephrotic syndrome?

A

lipid sediment, fatty casts, oval fat bodies, or free fat droplets in teh urine

37
Q

How does hypercoagulability occur in nephrotic syndrome?

A

Loss of coagulation inhibitors in the urine

Increased synthesis of procoagulatory factors by the liver

38
Q

How does the oedema occur in nephrotic syndrome?

A

Decreased oncotic pressure from the hypoalbumiaemia as well as primary renal sodium retention in the collecting tubules

39
Q

Why are patients with nephrotic syndrome at increased risk of infection?

A

Loss of immunoglobulins and complement in the urine

40
Q

Nephrotic syndrome is 1 of the 3 causes of severe oedema (anasarca); what are the other 2?

A

CHF

Severe hepatic disease

41
Q

What are the complications of nephrotic syndrome?

A

Proteinuria and oedema, which can become generalised (anasarca)

Protein malnutrition, with a negative nitrogen balance due to marked proteinuria

Hypovolaemia due to over-diuresis, particularly in the presence of hypoalbuminaemia

Acute kidney injury secondary to hypovolaemia, ischaemic injury, non-steroidal anti-inflammatory drugs

Hyperlipidaemia and accelerated atherosclerosis

Hypercoagulability causing arterial plus venous thrombosis.

Immunocompromised state and infections

Rapidly progressive glomerulonephritis

42
Q

What is the basis for diagnosing nephrotic syndrome?

A 
Hx and examination
Quantification of proteinuria
Urinalysis for casts
Serological studies
Renal biopsy
43
Q

What features should be included in taking a history in someone with suspected nephrotic syndrome?

A

PMH
Full medication history
FH of causative diseases
Previous know renal disease

44
Q

What features should be included in an examination of someone with suspected nephrotic syndrome?

A 
Assessment of oedema and severity
Features of hypoalbuminaemia
Protein malnutrition 
Xanthelasmata
Any additional features depending on ?cause
45
Q

What investigations should be done in someone with suspected nephrotic syndrome?

A 
Proteinuria quantification
Evaluation of fresh urine sampel for casts
Renal function
FBC
Lipid profile
Serum albumin
TFTs
HIV test
Serum complement
Any other tests depending on presenting features and clinical suspicians
46
Q

What imaging should be done in someone with suspected nephrotic syndrome?

A

Appropriate imaging of any suspected malignancies

Renal USS esp. if renal biopsy taken

47
Q

What group of patients with nephrotic syndrome do not usually need a renal biopsy?

A

Children
-90% minimal change disease so nothing will be seen on biopsy that aids diagnosis
Biopsy only for refractory cases

48
Q

What are the contraindications for percutaeous renal biopsy in nephrotic syndrome?

A

Bleeding diathesis resistant to correction
Multiple, bilateral renal cysts
Renal tumour Hydronephrosis
Active renal infection
Small kidneys secondary to chronic irreversible disease
Severe and resistant hypertension.

4 Finals (20 decks)

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