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General Medicine Pt1 > Nephrotic syndrome > Flashcards

Nephrotic syndrome Flashcards

1
Q

What are the characteristics of nephrotic syndrome?

A
  • Massive proteinuria (≥3.5g/d): frothy urine
  • Hypoalbuminaemia (≤30g/L)
  • Oedema
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2
Q

State three complications of nephrotic syndrome

A
  • Infections
  • AKI
  • Thromboembolisms: urinary loss of antithrombotic factors
  • Dyslipidaemia; hypercholesterolaemia; hypertriglyceridaemia
    • Impaired clearence
  • Abnormalities in coagulation/fibrinolysis
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3
Q

Request four investigations for nephrotic syndrome

A
  • Urine dipstick
  • Midstream urine for MCS: exclude UTI
  • Early morning urinary protein:creatinine or ACR
  • FBC; clotting
  • U+Es; LFTs; ESR; CRP; lipid profile
  • HbA1c; glucose
  • Renal biopsy
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4
Q

Describe the general management of nephrotic syndrome

A
  • Dietary sodium restriction + thiazide diuretic
    • Furosemide if unresponsive
  • Normal protein intake of 70g daily
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5
Q

List five causes of nephrotic syndrome

A
  • Primary (idiopathic) glomerular disease:
    • Minimal-change glomerular disease
    • Focal segmental glomerulosclerosis
    • Membranous glomerular disease
    • Membranoproliferative glomerulonephritis
  • Secondary glomerular disease:
    • Infection eg. HIV; hepatits B and C; syphilis; malaria
    • SLE; RA; HSP
    • Amyloidosis; diabetic nephropathy
    • Malignancy eg. myeloma; leukaemia; lymphoma
    • Pre-eclampsia
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6
Q

Give three features of minimal change glomerular disease

A

Most often affects children aged 2-4

  • Highly selective proteinuria
    • Usually loss of albumin without loss of immunoglobulins
  • Oedema: predominantly around face
  • Normal renal function; BP; and complement levels
  • Increased risk of infections
    • Especially UTIs and pneumococcal peritonitis
  • Does not progress to CKD, but can relapse
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7
Q

Describe the prognosis of minimal change glomerular disease

A

Prognosis is overall good, although relapse is common:

  • 1/3 one episode only
  • 1/3 infrequent relapses
  • 1/3 frequent relapses, which stop before adulthood
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8
Q

What is the management of minimal-change nephropathy

A
  • General management of nephrotic syndrome
    • Dietary sodium restriction + thiazide diuretic
    • Furosemide if unresponsive
    • Normal protein intake of 70g daily
  • High-dose corticosteroids
    • ​80% are steroid-responsive
  • Consider cyclophosphamide or ciclosporin
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9
Q

Define focal segmental glomerulosclerosis

A

Sclerotic glomerular lesion that affects some (not all) glomeruli, and some (not all) segments of each tuft

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10
Q

Describe the clinical features of focal segmental glomerulosclerosis

A

Common in children and young adults

  • Massive proteinuria: usually non-selective
  • May have haematuria; HTN; impaired renal function
  • Can progress to CKD (50% within 10 years)
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11
Q

Outline the management of focal segmental glomerulosclerosis

A
  • High-dose prednisolone
    • 50% response rate
  • Consider ciclosporin; cyclophosphamide
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12
Q

Describe the clinical features of membranous glomerulopathy

A

More common in adults, especially men

  • Asymptomatic proteinuria or frank nephrotic syndrome
  • Microscopic haematuria; HTN
  • 40% progress to CKD
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13
Q

What is the management of membranous glomeruler disease?

A

1/3 undergo spontaneous remission in 6-12 months

  • ACEi at maximum tolerated dose
  • Consider:
    • Cyclophosphamide + prednisone
    • Ciclosporin
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14
Q

Define amyloidosis

A
  • Systemic acquired or inherited disorder of protein folding
  • Extracellular deposition of abnormal insoluble fibrils
  • Causes progressive organ dysfunction and death
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15
Q

Name three clinical manisfestations of amyloidosis

A
  • Nephrotic syndrome
  • Heart failure
  • Autonomic and sensory neuropathies
  • Carpal tunnel syndrome
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16
Q

State 3 risk factors for diabetic nephropathy

A
  • Poor glycemic control
  • Hypertension
  • Male
  • Ethnicity
  • Social deprivation
17
Q

Describe the management of diabetic nephropathy

A

Diabetics screened annually using early morning urinary ACR

  • Normal protein diet (0.8-1 g/kg bodyweight)
  • Good glycemic control: target HbA1c <7%, 53 mmol/mol
  • Statins for dyslipidaemia
  • Target BP 130/80 mmHg using ACEi/ARBs
    • Additional diuretic: prevent hyperkalaemia

General Medicine Pt1 (25 decks)

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