Nephrotic syndrome

Question 1

Which diseases can lead to nephritic syndrome?

Answer 1

Diabetic nephropathy
Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy
Congenital nephrotic syndrome 
SLE
Amyloidosis

Question 2

What is nephrotic syndrome?

Answer 2

Increased filtration of macromolecules across the glomerular capillary due to structural and functional abnormalities of the glomerular podocytes
Hypoalbuminaemia
Oedema
Hypercholesterolaemia and hypertriglycarideaemia

Question 3

What causes membranoproliferazive glomerulonephritis?

Answer 3

Chronic infection (abscesses, IE,)
Cryloglobuminaemia secondary to hep C

Question 4

What are the clinical features of nephrotic syndrome?

Answer 4

Oedema of ankles, genitals and abdominal wall
Periorbital oedema and arms in severe cases
Proteinuria
Hypoalbuminaemia
hyperlipidaemia
Complications- hypertension, thromboembolic disorders, peritonitis

Question 5

What occurs in minimal change disease?

Answer 5

Nephrotic syndrome
Most common in children 
T cells attack the foot processes of podocytes (effacement), less of charge barrier so albumin can pass through 
Associated with Hodgkin's lymphoma 
No change seen on light microscopy

Question 6

What are the histological descriptions of glomerular pathology?

Answer 6

Global: whole glomerulus is diseased
Segmental: small patches of one glomerulus are damaged
Diffuse: >50% glomeruli
Focal: <50% glomeruli

Question 7

What changes predispose the development of venous thromboembolism in nephrotic syndrome?

Answer 7

Loss of antithrombin III

Protein C and S