Nephrotic syndrome: Flashcards
What is the classic triad of nephrotic syndrome?
- Proteinuria
- Hypoalbuminaemia
- Oedema (ascites/SOB)
Why are the features of the triad present?
Due to massive loss of protein from the kidneys (idopathic causes or 2ndry such as HSP). This causes low albumin which in turn reduces the oncotic pressure in the blood causing oedema.
What other feature is often present in nephrotic syndrome and why?
Hyperlipidaemia - due to ^ lipoprotein production to compensate for protein loss.
What is then an increased risk of during nephrotic syndrome?
Thombosis (due to reduced anticoagulation factors and ^ clotting factors) & ^ risk of infection
How is nephrotic syndrome confirmed?
Clinical features and confirmed proteinuria (24hr urine protein collection)
What is nephrotic syndrome typically caused by?
Minimal change disease (85-90%)
What is the treatment for nephrotic syndrome?
6 week course of steroids (prednisolone)
What is the prognosis of nephrotic syndrome?
> 60% will go on to relapse; a minority will go on to develop renal failure
What observations are typically performed in those with nephrotic syndrome?
- Daily weight
- U+Es
- Strict fluid input-output
- Diuretics if required
What are the two main types of nephrotic syndrome?
Steroid sensitive (90%)
Steroid resistant - no response after 4 weeks (10%) - investigate with biopsy
How do you describe a big and small non-blanching rash?
Petechial - <5mm
Purpuric - 5-9mm
Give some differentials for a non-blanching rash:
- Infection: meningococcal septicaemia
- Bleeding disorders: ITP, acute leukaemia, HUS
- Vasculitis: HSP
- Mechanical/trauma: recurrent coughing/vomiting; non-accidental injury
What is the typical aetiology of someone with HSP?
3-10 years old. Recent Hx of URTI
What is HSP classed at?
IgA vasculitis
What are the 4 classical features of HSP?
- Rash (purpuric)
- Joints affected (arthritis)
- Abdo pain
- Haematuria
OR
H - Haematuria
S - Skin (purpuric rash)
P - Pain (abdo and joints)
