Nephrotic Syndrome Flashcards
What is it?
Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine.
Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood.
Usually has group S+S: Oedema Proteinuria (PCR>200) Low albumin \+/- hypercholesterolaemia
Histology
Minimal change
How is it classified?
Steroid dependent, sensitive or resistent
SD, SS or SR
Symptoms
Insidious onset Oedema - starts around eyes then spreads everywhere Anorexia GI disturbance Infections Irritability Ascites Oliguria
What might you see in the urine?
Frothy
Albuminous+/-casts
Low sodium
What might you see in the blood?
Low albumin therefore low calcium
Urea and creatinine usually normal
When should a renal biopsy be done? 5 things!!!
Older children with any of the following:
haemtouria
high BP
high urea
protein loss which is unselective (i.e. large and small proteins)
Treatment failures
What is the main complications?
Sound lungy
What could be considered for children >2 yrs?
Pneumococcal peritonitis or spontaneous infections
Increased susceptibility to infection due to renal loss of immunoglobulins
Consider pneumococcal vaccination if >2 yrs
Treatment
Diet?
Fluids?
What about oedema?
When is an albumin infusion necessary?
What about if NS is steroid sensitive?
Get help
Eat healthily with no added salt and no high protein content
Fluid restriction to 800-1000mL/day
Give diuretics
Symptomatic hypovolaemic patients or severe diuretics-resistant oedema
Prednisolone which is weaned over time
Treatment
What should be given for SD NS?
Ciclosporin which is nephrotoxic so should monitor BP to minimise later renal failure.
Treatment
What if there is steroid toxicity and relapsing NS?
Consider cyclophosphamide.
