nephrotic syndrome Flashcards
what is the most common cause of AKI in children?
what is it caused by?
what is the most common age for H.U.S?
- haemolytic uraemic syndrome
- E.coli 157
- 6 months to 5 years
how will a child with H.U.S present?
- profuse diarrhoea, turning bloody 1 to 3 days later
- fever
- abdo pain
- vomiting
what investigations would you do for H.U.S?
- FBC: haemolysis, anaemia and thrombocytopenia
- Renal function and electrolytes: rise in urea and creatinine
- LDH: is high
- CRP
- clotting screen
what is the management of H.U.S?
- notifiable disease!
- supportive: fluid and electrolytes, antihypertensives, dialysis
what are the complications of H.U.S?
- intestinal strictures and perforations
- intussusception and rectal prolapse
- pancreatitis
- seizures
- AKI
- haematuria
- hypertension
- proteinuria
what is the criteria for nephrotic syndrome?
- proteinuria (>3-3.5 g/24 hours)
- hypoalbuminaemia <25g/L
- peripheral oedema
- severe hyperlipidaemia (total cholesterol often >10 mol/L)
all due to increased capillary wall permeability in glomerulus allowing protein to leak into urine
what is the age of onset for nephrotic syndrome?
what is most common cause?
- <6 years (M2:1F)
- minimal change glomerulonephritis
what are the causes of primary glomerular disease?
- minimal change (78%) glomerular disease
- FSGS (8%)
- membranous glomerular disease
- membranoproliferative glomerulonephritis
what are the broad causes of secondary glomerular disease?
- infection
- vascular disease
- metabolic (DM/ amyloidosis)
- inherited disease: alports, sickle cell
- malignancy
- nephrotoxic drugs
- pregnancy (pre-eclampsia)
- transplant rejection
how may nephrotic syndrome patients present?
- following viral URTI
- oedema: puffy pale face, swollen lips, periorbital oedema
- frothy urine
- leukonychia, xanthelasma
what investigations would you do in the urine?
what blood investigations?
- urinalysis and protein +++
- microscopy
- protein: creatinine ratio
- serum albumin
- U+Es (
how can nephrotic syndrome be managed?
- admit to hospital
- fluid restriction
- diuretics
- low salt diet
- corticosteroids (2-3 months)
- prophylactic penicillin
what is the prognosis of nephrotic syndrome?
- relapses common in 75%
- HSP carries a worse prognosis and may result in renal failure
what potential complications are there of nephrotic syndrome?
- increased risk of infection and thrombosis due to loss of antithrombin, plasminogen and Ig
- AKI and CKD
- pulmonary oedema
