Nephrotic syndrome

Question 1

Define:

Answer 1

A triad of:

• Proteinuria (>3.5g/24hrs)
• Hypoalbuminemia (<25g/L)
• Oedema - this is due to the decrease in albumin which leads to a fall in oncotic pressure

Common feature is to have hypercholesteremia

Question 2

Aetiology/risk factors:

Answer 2

Damage to the podyctes which makes the nephron more permeable and leaky.

In children the main cause is minimal change glomerulernephritis.

Question 3

What are the secondary causes of nephrotic syndrome:

Answer 3

SLE
Sickle cell anaemia 
HEP B/C
Diabetes mellitus 
Goodpastures 
HIV 
Drugs such as NSAIDS
Amyloidosis

Question 4

Epidemiology:

Answer 4

90% of cases in children are due to minimal change glomerularnephritis.

In adults the most common cause is diabetes or membranous glomerularnephritis

Question 5

Symptoms:

Answer 5

Pale skin 
Vomiting 
Tachycardia 
Family history of atopy 
Swelling - starts off in the face and spreads to limbs, abdomen and genitalia 

There may be symptoms of the underlying cause or complications

Question 6

Signs:

Answer 6

Ascites - shifting dullness, fluid thrill

Oedema - periorbital, peripheral and genitalia

Question 7

Investigations:

Answer 7

Bloods:

• FBC
• U+ES
• LFTS (low albumin)
• CRP/ESR
• Lipid profile (hyperlipidemia due to the liver trying to compensate.)
• Immunoglobulins
• Complement
• Glucose

Anti-dsDNA or ANA = SLE
Serology for HEP B/C
Blood film for malaria
Anti-BM Ab for goodpastures.

Urine = urinanalysis (high levels of protein), 24hr urine collection and MC&S

Renal ultrasound or biopsy

Doppler USS, renal angiogram and CT or MRI