Nephrotic Syndrome

Question 1

def

Answer 1

presence of:
1 proteinuria
2 hypoalbuminaemia
3 peripheral oedema

Question 2

what is the definition of proteinuria

Answer 2

> 3.5kg/24hrs

Question 3

what is the definition of hypoalbuminaemia

Answer 3

<30g/L

Question 4

what is also commonly seen in NS

Answer 4

hyperlipidaemia

thrombotic disease

Question 5

what distinguishes nephrotic and nephritic syndrome

Answer 5

nephrotic syndrome - urine has no RBCs

nephritic syndrome - urine has RBCs

Question 6

def of nephritic syndrome

Answer 6

AKI (renal dysfunction), HTN, active urinary sediment (RBCs)

Question 7

aetiology

Answer 7

primary diseases

secondary diseases

Question 8

what is the most common cause of NS in children

Answer 8

minimal change disease

Question 9

what is the most common cause of NS in older people

Answer 9

membranous nephropathy

Question 10

what is the most common cause of NS in adults

Answer 10

focal segmental glomerulosclerosis followed by minimal change nephropathy

Question 11

what are the causes of minimal change nephropathy

Answer 11

primary (idiopathic)

secondary to NSAIDs or Hodgkins

Question 12

what are causes of focal segmental glomerulosclerosis

Answer 12

primary (idiopathic)

secondary to HIV, obesity

Question 13

what are the causes of membranous nephropathy

Answer 13

idiopathic

secondary to hep B, malignancy, NSAIDs

Question 14

what is the link between NS and amyloidosis

Answer 14

responsible for 10% of NS cases

Question 15

what are glomeruli used for

Answer 15

sites of blood filtration

Question 16

what are 3 categories of proteinuria

Answer 16

glomerular
tubular
overflow

Question 17

what is glomerular proteinuria

Answer 17

filtration barriers of glomeruli are disrupted by disease, this leads to proteinuria

Question 18

how does the liver try to compensate for the loss of protein in NS

Answer 18

increases synthesis of albumin

Question 19

why is there hypoalbuminaemia if the liver is making more albumin to compensate for the proteinuria

Answer 19

due to failure of filtration there is loss of albumin in the urine

Question 20

why does hypercoagulability occur in NS

Answer 20

loss of inhibitors of coagulation in the urine and increased synthesis of procoagulatory factors by the liver

Question 21

why is there peripheral oedema in NS

Answer 21

combination of decreased oncotic pressure from hypoalbuminaemia as well as Na retention due to renal failure

Question 22

what is a normal output of protein in the urine

Answer 22

<150mg/day

Question 23

history

Answer 23

PMH/FH (diabetes, amyloidosis) and DH (NSAIDs) very important in NS
also any history of renal disease
1 oedema
2 foamy urine

Question 24

examination

Answer 24

oedema
white binding of the nails (Muehrcke’s lines) due to hypoalbuminaemia
signs of protein malnutrition (muscle wasting) due to proteinuria
xanthalasmata from hypercholesterolaemia

Question 25

what might a rash in NS indicate

Answer 25

SLE

Question 26

what might easy bruising and neuropathy indicate

Answer 26

amyloidosis

Question 27

investigations

Answer 27

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