Nephrotic syndrome

Question 1

What is the pathophysiology of nephrotic syndrome?

Answer 1

Inflammation of glomerulus = damage to podocytes = mass loss of protein e.g. albumin, Ig etc

Albumin loss = more in urine, less in blood = hypoalbuminaemia = decrease oncotic pressure = OEDEMA = liver makes more albumin AND increases cholesterol subsequently

Loss of Ig = increase infection risk

Question 2

What do podocyte foot processes do?

Answer 2

Maintain the filtration barrier and prevent protein loss

Question 3

What value of protein in the urine indicates nephrotic syndrome?

Answer 3

> 3.5g/24h

Question 4

What value of albumin in blood indicates hypoalbuminaemia of nephrotic syndrome?

Answer 4

<30g/L

Question 5

What are the primary causes?

Which is most common in children?

Which is most common in adults?

Answer 5

Minimal change disease - children

Focal segmental glomerulosclerosis - adults

Membranous nephropathy - adults

Question 6

What is the most secondary cause in adults?

Answer 6

DM

Question 7

Name 2 other 2nd causes of

Answer 7

Hep B/C/HIV

Drug-related - NSAIDs, ACEi

Question 8

What is the classical triad of SX?

What other SX?

Answer 8

Proteinuria
Hypoalbuminaemia
Oedema

Peripheral odema - spread to whole body
Frothy urine 
Hypercoagubility - DVT, MI
Recurrent infections, general fatigue, lethargy, poor appetite
Weakness, episodic abdo pain

Question 9

How does it present in children?

Answer 9

Facial swelling
Periorbital oedema
Can spread to whole body

Question 10

What IX do you need to do?

Answer 10

Urine dipstick - proteinuria, no haematuria
MCS of MSU - UTI

Bence-jones protein

Bloods:

• Hypoalbuminaemia
• FBC, U&E, LFT
• ESR, CRP, glucose
• Ig, hep B/C, HIV
• Coagulation screen
• Bone profile
• Glucose - DM

CXR - pleural effusion
USS

Renal biopsy

Question 11

Name 4 signs

Answer 11

Oedema - peripheral, facial, scrotal
Tiredness
Leukonychia
SOB - pleural effusion
Dyslipidaemia - xanthelasmata

Question 12

How is it MX?

Answer 12

Sodium + fluid restriction
High dose diuretic - furosemide
ACEi - for adults for proteinuria 
Corticosteroids - children
Abx for infection

If no response to corticosteroids - can give other immunomodulatory drugs e.g. cyclophosphamide, ciclosprin

Refer urgently to nephrologist
Does not usually require hospitalisation

Question 13

Name 3 complications of nephrotic syndrome

Answer 13

• Increased risk of infection
• Increased risk of thromboembolism which can result in renal vein thrombosis
• Hyperlipidaemia
• HypoCa - vit D and binding protein lost in urine
• Acute renal failure