Nephrotic Syndrome Flashcards
Why is looking for protein in the urine so important?
Nephritic Syndrome:
How does this relate to the nephrotic syndrome?
It is a marker of intrinsic kidney disease, indicating glomerular basement membrane leak or tubule damage.
It is a milder form of the nephrotic syndrome - still has haematuria nad proteinuria - basically some of the causes of intrinsic AKI
Healthy individuals loss <150mg/day of protein, a third of which is albumin.
Classification of albumin excretion is done over a 24 hr period.
Over how many micrograms in a 24 hr period is detected on a dipstick?
Over how many grams is classed as nephrotic syndrome?
300-3000mg
> 3g/24hrs
Nephrotic syndrome is a triad of what?
Proteinuria (>3g/24hrs)
Hypoalbuminemia
Oedema - because of protein loss
Causes:
What primary renal disease could cause significant proteinuria?
What secondary renal diseases could cause significant loss?
Glomerulonephritis
Diabetic nephropathy
Pre-eclampsia
Autoimmune - SLE, vasculitis
Causes:
What are some causes of modest proteinuria?
Tubulointerstitial disease
Glomerular disease
U/LUTI
Kidney stones
Presentations:
What happens due to loss of albumin?
What does the urine look like?
Why do they get thrombosis?
Why are they at risk of infection?
Why do they get hypercholesterolaemia?
Oedema - generalised!!
Frothy urine
Liver compensates for protein loss by increasing production of proteins including clotting factors.
Urinary loss of IgG - it is a protein
Compensatory liver production of lipoproteins
Investigations - Testing pathways:
(1) If protein detected on the dipstick, benign causes need to be ruled out.
- Orthostatic proteinuria is a cause. What is it?
- What sign of infection may cause proteinuria?
- How does exercise cause it?
- What is done to quantify the albumin levels if it is detected on urine dipstick?
(2) If proteinuria is persistent, what should then be done?
(3) If nephrotic syndrome is confirmed, what is needed to confirm the cause?
Normal urinary protein excretion during the night but increased excretion during the day, associated with activity and upright posture.
Fever
Strenuous exercise increases glomerular filtration of low-molecular-weight proteins (β2-microglobulin), which overwhelm the reabsorbing capacity of the tubular apparatus, causing temporary dysfunction and tubular proteinuria. Thus, the pathophysiology is mixed, with a major contribution from glomerular proteinuria. ACR - albumin:creatinine ratio ========= Bloods ========= Renal biopsy
Investigations - Quantifying protein:
Which one is more sensitive for lower protein levels, ACR or PCR?
What time of the day is it typically done?
Investigations - Urinalysis:
- What needs to be excluded?
ACR
In the morning - Normal urinary protein excretion during the night but increased excretion during the day, associated with activity and upright posture.
UTI - especially upper
Investigations - Bloods:
Why is cholesterol measured?
Why are LFT’s done?
Why is clotting done?
Investigations - Imaging:
- What is first line?
- Why may a CXR be needed?
Hypercholesterolaemia is common due to liver compensation
To look for other causes for low albumin or fluid retention
Thrombosis common - Liver compensates for protein loss by increasing production of proteins including clotting factors.
USS
Looking for pleural effusion or pulmonary oedema
Management:
(1) Reducing oedema:
- What 2 things should be restricted?
- What med should they be put on?
- What should be used monitor this Rx?
(2) Proteinuria:
- What type of drugs reduces the intraglomerular pressure, therefore reducing protein excretion?
(3) Complications are dealt with accordingly - e.g. hypercoagulability - anticoags used
(4) What is needed for glomerulonephritis or autoimmune diseases?
Daily weighing
Salt and fluid restriction
High dose loop diuretic
ACEi
ARBs
Immunosuppression
