Nephrotic syndrome

Question 1

Definition

Answer 1

• Proteinuria (>3g/day)
• Oedema
• Hypoalbuminaemia (<30g/L) + reduced total serum protein.

Renal function usually preserved

Question 2

Complications

Answer 2

Infection

• decreased Ig and complement activity.
• Infections include peritonitis, pneumococcus.
• Venous thromboembolism (VTE)
• Hyperlipidaemia.
• AKI

Question 3

Causes

Answer 3

Primary causes

• Minimal change disease
• Membranous nephropathy
• Mesangiocapillary Gn
• Focal segmental glomerulosclerosis

Secondary causes

• Diabetes
• Amyloidosis
• Hepatitis B (membranous), C (MCGN)
• SLE (membranous)
• Drugs (membranous): NSAIDs, anti-TNF, gold, penicillamine

Question 4

Diagnosis

Answer 4

Urine dipstick (not diagnostic)

• Presence of proteins
• No WCC, blood or nitrites.

Protein creatinine ratio
- >180

Albumin creatinine ratio
- >300

Renal biopsy
- Final diagnosis of cause

Question 5

Treatment

Answer 5

Oedema

• Loop diuretics
• Fluid restriction

Proteinuria
- ACEi/ ARB

Treat underlying cause

Question 6

Focal segmental glomerulosclerosis

• Causes
• Histology

Answer 6

Primary= idiopathic

Secondary

• IgA nephropathy
• Vasculitis
• SCD
• HIV

Histology
- Segmental sclerosis of glomerulus.

Question 7

Treatment

Answer 7

If proteinuria is nephrotic
- Corticosteroid

Secondary causes
- Treat underlying disease