Nephrotic syndrome and acute nephritis

Question 1

Presentation of nephrotic syndrome (4)

Answer 1

proteinuria

oedema

hypoalbuminaemia (<30)

may also get hyperlipidaemia and thrombophilia

Question 2

Features of minimal change disease (2)

Answer 2

most common cause of nephrotic syndrome in children-often precipitated by respiratory tract infection

90% are steroid-sensitive, 10% steroid-resistant

Question 3

Mx and prognosis of minimal change disease (5)

Answer 3

prednisolone PO for 4wks. Steroid resistant if no remission w/i 4wks.

biopsy if no remission after 8wks

colloid to raise intravascular volume

may need prophylactic Abx (penicillin) and pneumococcal vaccine

1/3 never recur, 1/3 have few relapses, 1/3 have frequent relapses

Question 4

Steroid-resistant causes of nephrotic syndrome (3)

Answer 4

FSGS: HIV, HTN

Mesangiocapillary: HCV

Membranous: HBV, SLE

Question 5

Factors suggesting congenital nephrotic syndrome

Answer 5

placenta >25% baby’s wt.

Question 6

Presentation of acute nephritis (4)

Answer 6

volume overload

decreased UO

HTN>encephalopathy>seizures

haematuria and proteinuria

Question 7

Causes of nephritis (5)

Answer 7

post-strep GN

IgA nephropathy

vasculitis: HSP, polyarteritis nodosa, SLE, Wegener’s, microscopic polyangitis

anti-GBM disease-Goodpasture’s

familial nephritis

Question 8

Features and Dx of post-strep GN

Answer 8

presents 2-3 wks after strep sore throat

Dx w. ASOT

Question 9

Rx of Post-Strep GN (4)

Answer 9

salt restriction

furosemide

penicillin

CCBs if needed to control BP

Question 10

Presentation of IgA nephropathy

Answer 10

presents 2-3d after URTI

Question 11

Familial nephritic syndromes and their features (4)

Answer 11

Alport’s:

• X-linked
• ESRF w. sensorineural deafness and ocular defects
• female carriers may have haematuria

benign familial haematuria:
-asymptomatic haematuria w. no hearing loss