Nephrotic Syndrome and Glomerulonephritis

Question 1

Nephrotic Syndrome

Answer 1

• excessive excretion of protein in urine from increased glomerular filtration permeability
• selective (albumin only) or non-selective (most serum proteins)
• edema formation from decreased plasma oncotic pressure
• liver increases protein synthesis - hyperlipidemia and lipiduria
• reduced volume stimulates ADH - increased reabsorption of water

Question 2

Nephrotic Syndrome: Cause

Answer 2

• congenital
• idiopathic
• secondary disorders

Question 3

Nephrotic Syndrome: Clinical Findings (History)

Answer 3

• history of allergy
• edema is cardinal feature, especially periorbital
• low urine production
• GI symptoms
• respiratory difficulties - secondary to edema

Question 4

Nephrotic Syndrome: Clinical Findings (Physical Examination)

Answer 4

• edema in tissues of low resistance/dependent
• anorexia, irritability, fatigue
• muscle wasting, malnourishment, growth failure
• hypertension
• chronically ill appearing

Question 5

Nephrotic Syndrome: Management

Answer 5

• control edema/await remission
• consultation w/ nephrologist
• hospitalization for severe symptoms
• prednisone 2mg/kg/day (remission indicated by diuresis)
• noncorticosteroid medication prescribed by nephrologist if steroid resistant/dependent
• no limitation on activity; salt restriction during active period
• diuretics/albumin replacement in acute phase
• daily home testing
• routine immunizations except during immunosuppression
• prompt tx of infection

Question 6

Nephrotic Syndrome: Complications

Answer 6

• susceptible to infections
• hyper or hypotension
• thromboembolism

Question 7

Nephritis

Answer 7

• noninfectious

- inflammatory response of kidneys

Question 8

Nephritis: Clinical Manifestations

Answer 8

• variable hypertension
• edema
• proteinuria
• hematuria
• acute, intermittent, or chronic

Question 9

Glomerulonephritis (GN): Primary vs. Secondary

Answer 9

GN = inflammation in glomeruli

primary: glomerular impairment
secondary: renal involvement secondary to systemic disease

Question 10

Interstitial Nephritis

Answer 10

inflammation in interstitium

Question 11

Poststreptococcal glomerulonephritis: Management

Answer 11

• supportive w/ spontaneous resolution
• hospitalization if severe oliguria, hypertension
• antibiotics for positive cultures
• resolution begins w/ diuresis
• gross hematuria persists 1-2 weeks; urine abnormal up to 6-12 weeks; microscopic hematuria up to 2 years
• good outcome

Question 12

Intermittent Gross Hematuria/Proteinuria Syndromes

Answer 12

• IgA nephropathy/Berger disease (poor outcome)
• Alport syndrome (hereditary)
• Benign recurrent