Nephrotic Syndrome Flashcards
What is nephrotic syndrome defined as?
A combination of:
- Heavy proteinuria
- Hypoalbuminaemia
- Oedema
- Hyperlipidaemia
What is considered heavy proteinuria?
PCR >200mg/mmol
What is considered hypoalbuminaemia?
Serum albumin <25g/L
What is the peak age of onset of nephrotic syndrome?
<6 years old
How can nephrotic syndrome be classified?
- Primary vs Secondary
- Steroid sensitive vs Steroid dependant vs Steroid resistant
What are type are the majority of cases of nephrotic syndrome?
Steroid sensitive
What features suggest a steroid sensitive nephrotic syndrome?
- Age 1-10 years
- No macroscopic haematuria
- Normal BP
- Normal complement levels
- Normal renal function
When can congenital nephrotic syndrome occur?
In the first 3 months of life
Is congenital nephrotic syndrome common?
No it is rare
Who is congenital nephrotic syndrome more common in in the UK?
Children of consanguineous parents
What is congenital nephrotic syndrome associated with?
High mortality
Why is congenital nephrotic syndrome associated with high mortality?
Due to combinations of hypoalbuminaemia
What happens in nephrotic syndrome?
The glomeruli are affected by inflammation or hyalinisation allowing proteins to pass through cell membranes and appear in the urine
What proteins can be lost in nephrotic syndrome?
- Albumin
- Anti-thrombin
- Immunoglobulins
Why does oedema occur in nephrotic syndrome?
Albumin is the main protein that maintains oncotic pressure preventing leakage of fluid into the extracellular medium, its loss results in oedema
What is the common cause of steroid sensitive nephrotic syndrome?
Minimal change glomerulonephritis
What can cause steroid resistant nephrotic syndrome?
- Focal segmental glomerulosclerosis
- Membranoproliferative glomerulonephritis
- Membranous nephropathy
What are the risk factors for developing nephrotic syndrome?
- Male gender
- Indian subcontinental ethnicity
What is the main non-urinary symptom of nephrotic syndrome?
Breathlessness
What can cause breathlessness in nephrotic syndrome?
Pleural effusion and abdominal distension
What signs can be seen on examination of a child with nephrotic syndrome?
- Periorbital oedema
- Scrotal/vulval/leg/ankle oedema
- Ascites
What blood tests should be performed when investigating nephrotic syndrome?
- FBC
- ESR
- U&E’s
- Creatinine and albumin
- Complement levels (C3 and C4)
What urine tests should be conducted?
- Dipstick for protein
- Urine microscopy and culture
- Urinary sodium concentration