Nephrotic Syndrome

Question 1

Nephrotic Syndrome Definition

Answer 1

• Massive proteinuria and hypoalbuminaemia
• Increased permeability of serum protein through damaged basement membrane
• Aetiology is more heterogeneous in adults so relies more heavily on biopsy

Question 2

Nephrotic Syndrome Aetiology

Answer 2

• Focal segmental glomerulosclerosis and membranous nephropathy are most common primary causes
• DM most common secondary cause
• Minimal change disease most common in children
• Infection, collagen vascular disease, metabolic disease

Question 3

Nephrotic Syndrome Presentation

Answer 3

• In children, facial swelling and periorbital oedema earliest signs
• Adults present with peripheral oedema
• Frothiness in urine
• VTE, MI
• Recurrent infections, weakness
• Leukonychia
• Breathlessness (pleural effusion, fluid overload)

Question 4

Nephrotic Syndrome Investigations

Answer 4

• Urinalysis
• MSU for C/S to exclude UTI
• Early morning protein:creatinine ratio or ACR
• Bloods
• Lipid profile

Question 5

Nephrotic Syndrome ACR Ranges

Answer 5

• <3 normal
• 3-30 mildly raised
• > 30 severely raised

Question 6

Nephrotic Syndrome Management

Answer 6

• Sodium restriction
• ACEi
• Statin
• Treat oedema with furosemide ± spironolactone
• Most children respond to corticosteroids and restriction