Nephrotic Syndrome Flashcards
What is a syndrome
Syndrome is a collection of findings signs and symptoms found on examination and history and lab results and they describe a typical presentation
How does it nephrotic syndrome present
Oedema due to low oncotic pressure in the capillaries and this happens quickly
Have a low serum albumin this causes the oedema
High proteinuria or ACR
Hyper cholesteroaemia
eGFR usually normal may be slightly low due to the low volume
How do you assess someone with nephrotic syndrome
You take the history and examine them looking for a likely cause
You may need to do a biopsy was usually needed and it’s not a diagnosis in its own right
Immunology and serology you look for HBV HCV HIV and autoimmune conditions
What are the causes of nephrotic syndrome
You combine history examination renal biopsy and immunology findings
Primary diseases where there is no additional underlying cause that can be found
Minimal change disease
Membranous nephropathy
Focal segmental glomerular sclerosis
It may have underlying membranous nephropathy and which could be cancer
FSGS could be HIV
Minimal change could be lymphoma and therefore will become secondary causes
Could be systemic causes Diabetes syndrome can appear many years after diagnosis SLE myeloma HIV HBV
How do you develop proteinuria
There are changes in the podocytes they lose their thought processes and they are no longer an affective filtration barrier
How to manage nephrotic syndrome
General management
Salt +- water restriction loop diuretics to reduce oedema ACE inhibitors /ARBS to reduce the proteinuria
Specific Depends on the underlying cause Immunosuppression in SLE Antivirals in HIV and HBV Steroids in minimal change disease and chemotherapy in myeloma
Complications of nephrotic syndrome
Normally you have normal renal function
But you can get an AKI due to reduced to circulating volume a prerenal AKI due to the decreased albumin decreased oncotic pressure and hypovolaemia you get reduced perfusion to the kidneys
VTE due to loss of pro and antithrombotic proteins so you need LMWH
Infection due to low immunoglobulins which can be lost in the urine
