Nephrotic syndrome

Question 1

Define nephrotic syndrome

Answer 1

Trio of findings-proteinuria, Hypoalbuminia and oedema
but can only 1 of those but very severe

caused by a constellation of diseases-including nearly all glomerularnephritises

Question 2

Aetiology and risk factors of nephrotic syndrome

Answer 2

Most common in children-minimal change
young adults-focal segmental and minimal change
Membranous in older adults
diabetic Gn with those with hx of GN
amyloidosis, SLE, multiple myeloma are also causes
Alport-kidney change, hearing loss and eye abnormal

common differentials:

Minimal change disease
Focal segmental glomerulosclerosis (FSGS)
Membranous nephropathy
Diabetic nephropathy

Question 3

Epidiemology of Nephrotic syndrome

Answer 3

Rare but important sign of kidney diseases-dont want to miss it

Question 4

Signs and Sx of Nephrotic syndrome

Answer 4

PC might be foamy urine and oedema/swelling
ask about long standing inflam (SLE, but also amyloidosis))
ask about diabetes

identify drugs being taken-NSAIDS can cause nephrotic syndrome
Myeloma also

Odema likely around legs and face-periorbilal
can get leukonychia (from hypoalbuminia)
weight gain
xanthelasma

rashes (SLE), bruising, (amylodosis), blood in stools (GI malignancy), fundoscopy (diabetes) can give clue about causes

Question 5

Investigations of Nephrotic syndrome

Answer 5

24h urine collection need a good measure of proteinuria->3.5g per day lost
Hypoalbuminia-

assess lipids-often high LDL
FBC-
GFR-can be lowered
TSH-can be lowered

renal biopsy can give a good clue of cause
Complement levels too
Autoimmune antibodies
Imaging-CT for malignancy around body-can be liked
renal USS-