Nephrotic syndrome Flashcards
What are the 3 key features of nephrotic syndrome?
- Proteinuria
- Oedema
- Ascites
What is the earliest sign of nephrotic syndrome?
Periorbital oedema, esp. on waking
Why might a child with nephrotic syndrome be breathless?
Pulmonary oedema
How is nephrotic syndrome Dx?
Heavy proteinuria and low plasma albumin
What is the cause of nephrotic syndrome?
Unkown, but may be secondary to HSP and other vasculitisis’, e.g. SLE, or infections (e.g. malaria) or allergens
What are the different types of nephrotic syndromes?
- Minimal change disease
- Glomerulonephritis
- Abnormal glomerular basement membrane
- Focal segmental glomerulosclerosis
- Membranous nephropathy
- Membranoproliferative glomerulonephritis
What proportion of children have steroid-sensitive nephrotic syndrome?
85-90%
What often precedes steroid-sensitive nephrotic syndrome?
Respiratory infection
What are the features that suggest a nephrotic syndrome will be steroid-sensitive?
- Age 1-10y/o
- No macroscopic haematuria
- Normal BP
- Normal complement
- Normal renal function
What investigations should be ordered when presented with a nephrotic syndrome?
- Urine dipstick - protein
- Bloods - FBC; ESR; U&Es; creatinine; albumin
- Complement - C3, C4
- Throat swab
- Urine MC&S
- Urine sodium conc
- Hep B/C screen
- Malaria screen if have travelled abroad
What is the usual regime of steroids in steroid-sensitive nephrotic syndrome?
60mg/m2 per day for 4 weeks, then alternate days of 40mg/m2 per day for 4 weeks, and then stop
What is the median time for the urine to become protein free in a child taking steroids for nephrotic syndrome?
11 days
When is a renal biopsy indicated?
When children do not respond within 4-8 weeks
What are the complications of nephrotic syndrome?
- Hypovolaemia - the intravascular compartment becoming volume depleted in oedema
- Thrombosis
- Infection
- Hypercholestrerolaemia
Why are children with nephrotic syndrome at increased risk of thrombosis?
Hypercoaguable state due to:
- Urinary loss of antithrombin III
- Thrombocytosis from steroids
- Increased synthesis of clotting factors
- Raised haematocrit
