Nephrotic syndrome

Question 1

Define nephrotic syndrome

Answer 1

triad of:

Proteinuria >3.5g/24 hours
Hypoalbuminaemia <30g/L
Peripheral oedema
+/- hypercholesterolaemia

pathognomic of glomerular disease

Question 2

Common causes of nephrotic syndrome?

Answer 2

Children - minimal change disease

Adults - Focal Segmental Glomerulosclerosis , membranous nephropathy primary & secondary, minimal change, IgA, DM, SLE, Amyloidosis

Question 3

SSx of nephrotic syndrome

Answer 3

dyslipidaemia
thrombotic disease (loss of antithrombin)
infections (loss of Ig)

Question 4

What are risk factors for minimal change disease in children?

Answer 4

viral illness

hodgkins lymphoma

Question 5

SSX minimal change disease

Answer 5

facial oedema
ascites
abdo pain
N&V
scrotal oedema

Question 6

Ix for minimal change

Answer 6

• urinalysis to check for protein.
  
  • Typical results show 3+ (30 g/L [3 g/dL]) to 4+ (200 g/L or more [20 g/dL or more]) proteinuria on dipstick.
  • Absence haematuria
• 24-hour urine protein
  
  • > 50 mg/kg/day
• Urine PCR
  
  • Nephrotic-range proteinuria can vary by age and size of child. For example, a ratio of 1 (about 1 g/24 hours) in a 20 kg patient may signify nephrotic-range proteinuria. In an adolescent patient, a ratio of 1 represents mild to moderate proteinuria
• Albumin
• Lipids
• GFR normal
• U&E
• Renal USS

Question 7

Mx minimal change

Answer 7

• Steroids
• Fluid restriction
• (tacrolimus if steroid-resistant) 
• Albumin
Furosemide

Question 8

what is FSGS and RFs?

Answer 8

• Focal segmental glomerulosclerosis (FSGS) is a chronic pathological process caused by injury to podocytes in the renal glomeruli. It manifests initially with proteinuria, which progresses to nephrotic syndrome and ultimately to end-stage renal failure.

• Black
• Male
• HIV / CMV