Nephrotic syndrome

Question 1

What is nephrotic syndrome?

Answer 1

1. Proteinuria >3-4.5g/day
2. Hypoalbuminaemia<30g/L
3. Raised cholesterol>even>10mmol/L
4. Anascara (generalised oedema)

Question 2

What are other features of nephrotic syndrome?

Answer 2

1. Thrombophillia: loss of antithrombin III in urine with DVT and renal vein thrombosis
2. Renal loss of immunoglobulin inc risk of sepsis
3. Renal vein thrombosis causes acute renal angle tenderness, pain and haematuria

Question 3

What are the primary causes of Nephrotic syndrome

Answer 3

1. Minimal change disease (massive loss of protein)
2. Focal segmental glomerulosclerosis
3. Membranous nephropathy

Question 4

What are the secondary causes of Nephrotic syndrome?

Answer 4

1. Diabetes Mellitus
2. Amyloid
3. Myeloma
4. Preeclampsia
5. Drugs: Gold, Penicillamine, captopril, NSAIDS
6. SLE
   Malignancy, Lymphoma, Carcinoma, CLL(Chronic lymphocytic leukemia)

Question 5

What clinical signs are there?

Answer 5

1. Oedema in morning involving the face
2. Anasarca is massive generalise oedema
3. Frothy urine from proteinuria

Question 6

What investigations are carried out?

Answer 6

1. FBC + Clotting (renal biopsy)
2. Low serum albumin
3. Urine protein > 3g/L
4. CRP & ESR
5. Immunoelectrophoresis
6. C3 and C4 low in SLE
7. CXR malignancy
8. Renal ultrasound
9. Raised cholesterol and trigs

Question 7

What is the management of Nephrotic Syndrome?

Answer 7

1. Determine cause - biopsy maybe needed
2. Salt restriction
3. Diuretics - Thiazide or loop diuretics or Metolazone
4. IV salt poor albumin
5. LMWH as risk of DVT/PE
6. Frequent weights to assess weight

Question 8

Why is there an increased risk of venous thrombosis in patients with Nephrotic syndrome?

Answer 8

Due to loss of antithrombin III in the urine