Nephrotic Syndrome

Question 1

Define Nephrotic Syndrome?

Answer 1

It is characterised by a triad of:

• Proteinuria (> 3 g/24 hr)
• Hypoalbuminaemia (< 30 g/L)
• Oedema

Hypercholesterolaemia is also a common feature

Question 2

What is Nephrotic Syndrome most commonly caused?

Answer 2

Minimal Change glomerulonephritis in children

Question 3

What are the other causes of Nephrotic Syndrome?

Answer 3

Diabetes Mellitus 
Sickle cell disease 
Amyloidosis 
Malignancies (lung and GI adenocarcinomas)
Drugs (e.g. NSAIDs)
Alport's syndrome
HIV

Question 4

What is the epidemiology of Nephrotic Syndrome?

Answer 4

90% of nephrotic syndrome in children is due to minimal change glomerulonephritis
Most common cause of nephrotic syndrome in ADULTS:
- Diabetes Mellitus
- Membranous glomerulonephritis

Question 5

What are the presenting symptoms of Nephrotic Syndrome?

Answer 5

Family history of atopy (in those with minimal change glomerulonephritis)
Family history of renal disease
Swelling of face, abdomen, limbs, genitalia (due to hypoalbuminaemia)
Symptoms of the underlying cause (e.g. SLE)
Symptoms of complications

Question 6

What are the signs of Nephrotic Syndrome?

Answer 6

Oedema: periorbital, peripheral, genital
Ascites: fluid thrill, shifting dullness

Question 7

What investigations do we do for Nephrotic Syndrome?

Answer 7

Bloods 
Tests to identify the cause
Urine 
Renal US 
Renal Biopsy 
Other Imaging

Question 8

What bloods do we do for Nephrotic Syndrome?

Answer 8

FBC 
U&Es 
LFTs (low albumin)
ESR/CRP
Glucose 
Lipid profile (check for secondary hyperlipidaemia)
Immunoglobulins 
Complement

Question 9

What tests do we do to idenitfy if SLE is the cause of Nephrotic Syndrome?

Answer 9

ANA

anti-dsDNA antibodies

Question 10

What investigations do we do to identify if infections are the cause of Nephrotic Syndrome?

Answer 10

Group A B-haemolytic streptococcal infection (ASO titre)
HBV infection (serology)
Plasmodium malariae (blood film)

Question 11

What test do we to to check whether Goodpasture’s Syndrome is the cause of Nephrotic Syndrome?

Answer 11

anti-glomerular basement antibodies

Question 12

What investigations do we do to check whether Vasculitides is the cause of Nephrotic Syndrome?

Answer 12

Polyangiitis with granulomatosis
microscopic polyarteritis (check ANCA)

Question 13

What do we look at in the Urine for Nephrotic Syndrome?

Answer 13

Urinalysis (check protein and blood)
MC&S
24 hr colletion (calculate creatinine clearance and 24 hr protein excretioN)

Question 14

Why do we do Renal US for Nephrotic Syndrome?

Answer 14

Exclude other causes (e.g. reflux nephropathy)

Question 15

What is the other imaging we do for Nephrotic Syndrome?

Answer 15

Doppler US
Renal angiogram
CT or MRI (if renal vein thrombosis suspected)