Nephrotic Syndrome Flashcards
def
presence of:
1 proteinuria
2 hypoalbuminaemia
3 peripheral oedema
what is the definition of proteinuria
> 3.5kg/24hrs
what is the definition of hypoalbuminaemia
<30g/L
what is also commonly seen in NS
hyperlipidaemia
thrombotic disease
what distinguishes nephrotic and nephritic syndrome
nephrotic syndrome - urine has no RBCs
nephritic syndrome - urine has RBCs
def of nephritic syndrome
AKI (renal dysfunction), HTN, active urinary sediment (RBCs)
aetiology
primary diseases
secondary diseases
what is the most common cause of NS in children
minimal change disease
what is the most common cause of NS in older people
membranous nephropathy
what is the most common cause of NS in adults
focal segmental glomerulosclerosis followed by minimal change nephropathy
what are the causes of minimal change nephropathy
primary (idiopathic)
secondary to NSAIDs or Hodgkins
what are causes of focal segmental glomerulosclerosis
primary (idiopathic)
secondary to HIV, obesity
what are the causes of membranous nephropathy
idiopathic
secondary to hep B, malignancy, NSAIDs
what is the link between NS and amyloidosis
responsible for 10% of NS cases
what are glomeruli used for
sites of blood filtration
what are 3 categories of proteinuria
glomerular
tubular
overflow
what is glomerular proteinuria
filtration barriers of glomeruli are disrupted by disease, this leads to proteinuria
how does the liver try to compensate for the loss of protein in NS
increases synthesis of albumin
why is there hypoalbuminaemia if the liver is making more albumin to compensate for the proteinuria
due to failure of filtration there is loss of albumin in the urine
why does hypercoagulability occur in NS
loss of inhibitors of coagulation in the urine and increased synthesis of procoagulatory factors by the liver
why is there peripheral oedema in NS
combination of decreased oncotic pressure from hypoalbuminaemia as well as Na retention due to renal failure
what is a normal output of protein in the urine
<150mg/day
history
PMH/FH (diabetes, amyloidosis) and DH (NSAIDs) very important in NS
also any history of renal disease
1 oedema
2 foamy urine
examination
oedema
white binding of the nails (Muehrcke’s lines) due to hypoalbuminaemia
signs of protein malnutrition (muscle wasting) due to proteinuria
xanthalasmata from hypercholesterolaemia
what might a rash in NS indicate
SLE
what might easy bruising and neuropathy indicate
amyloidosis
investigations
1 proteinuria
-either <3.5g/24hrs
- >300mg/mmol on protein-to-creatinine ratio
2 bloods
-FBC, UEs (high Na)
-low albumin
3 tests to differentiate cause of NS, imaging for malignancy, renal USS + biopsy
