Nephrotic Syndrome

Question 1

What is nephrotic syndrome?

Answer 1

Triad of
proteinuria greater than 3g/24hr (PCR above 300 or ACR above 250)
hypoalbuminaemia (less than 30)
oedema

Question 2

Which three body systems can cause oedema?

Answer 2

Liver
Cardiac
Renal

Question 3

What is the aetiology of nephrotic syndrome?

Answer 3

Can be primary or secondary. 
Primary:
Minimal change disease
Membranous nephropathy
FSGS
Membranoproliferative GN
Secondary:
Lupus
Diabetes M
Myeloma
Amyloid
Pre-eclampsia

Question 4

What is the pathophysiology of nephrotic syndrome?

Answer 4

Podocyte, glomerular basement membrane or endothelial cell pathology

Question 5

What is the pathology of minimal change disease?

Answer 5

Abnormal function of the podocytes.

Question 6

What is the pathology of membranous nephropathy?

Answer 6

Immune mediated damage of the podocytes

Question 7

What is the pathology of focal segmental glomerulosclerosis?

Answer 7

Podocyte injury or death

Question 8

What is the pathology or membranoproliferative GN?

Answer 8

Pathology in the GBM or endothelial cell

Question 9

What is the presentation of nephrotic syndrome?

Answer 9

Rapid, severe, pitting oedema.

Question 10

What are the differentials of rapid onset oedema?

Answer 10

Nephrotic syndrome Malignancy
Chronic infection
CCF
Liver disease

Question 11

What are the complications of nephrotic syndrome?

Answer 11

Thromboembolism
Infection
Hyperlipidaemia

Question 12

How do we manage nephrotic syndrome?

Answer 12

Salt restriction
Fluid restriction (1-1.5L/24hrs)
Diuretics (lose .5-.75L/day)
ACEi/ARB
Role of anticoagulation (loss of protein means loss of AT3 and protein C and S which usually help anticoagulation)