Nephrotic syndrome (Complete) Flashcards
Define nephrotic syndrome
Presence of proteinuria (>3.5 g/24 hours), hypoalbuminaemia (<30 g/L), and peripheral oedema
List some causes of nephrotic syndrome (7)
Minimal change disease (Type of kidney disease characterised by large loss of protein in the urine due to damage to the glomeruli often on a level not detcted by normal microscopes)
Congenital nephrotic syndrome
Focal segmental nephroscleorsis (disease in which scar tissue develops on the glomeruli)
Membranous nephropathy (damage or thickening of the glomeruli)
Diabetic nephropathy and Non-diabetic renal disease
Membranorpoliferative glomerulonephritis (auto-immune damage to glomeruli)
Malignant hypertension (High BP that comes on suddenly and quickly).
Amyloidosis
Systemic lupus erythematosus
Diabetes
What 3 causes of nephrotic syndrome tend to present mainly in children?
Minimal change disease
Congenital nephrotic syndrome
Myeloproliferative glomerulonephritis
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
What is the most common cause of nephrotic syndrome in adults?
Membraneous glomerulonephritis
List 4 examples of infections which can increase risk of developing nephrotic syndrome.
Hepatitis B and C
HIV
Malaria
Untreated strep infection
List examples of medications that increase the likelihood of developing nephrotic syndrome.
NSAIDs
Pamidronate (Osteoporosis)
Lithium (e.g. BPD)
Gold (Rheumatoid arthiritis)
Penicillamine (Wilson’s disease)
List examples of over-the-counter or herbal remedies that can increase likelihood of developing nephrotic syndrome
Chinese herbal remedies
Mercurial skin-lightening creams
In general, the evaluation of nephrotic syndrome should be done promptly, but it is not a medical emergency. In which circumstance would you consider hospital admission however? (2)
Rapid deterioration of renal function (indicated rapidly progessing glomerulonephritis)
Severe nephrotic syndrome in which a patient may need to be admitted for intravenous diuresis especially if there is an AKI.
What are the 2 main clincal signs/symtpoms of nephrotic syndrome?
Odema predominantly in the legs (Can progress into anasarca in extreme cases)
Foamy urine
List examples of associated signs/symptoms that may present alongside nephrotic syndrome.
Signs of malignancy: Cough, weight loss, night sweats, a change in bowel habits, gatrointestinal blood loss
Signs of SLE: Rash, mouth ulcers, or arthralgias
Signs of Fabry’s disease (e.g., painful neuropathy)
List examples of physical signs that may present in patients with nephrotic syndrome. (4)
Mild oedema of the legs
Anasarca (Peri-oribital and facial swelling more likely to be nephrotic versus other causes e.g. cardiac)
White banding of the nails (due to hypoalbuminaemia aka Muehercke lines[https://en.wikipedia.org/wiki/Muehrcke%27s_nails]
Lean body mass (in heavy proteinuria however may be concealed by weight gain of odemea)
Xanthelasmata (hypercholesteroaemia)
N.B. Can present with other signs of underlying pathology such as rash in SLE, easy bruising and neuropathy with amyloidosis ect).
Patients with nephrotic syndrome are at risk of which 2 complications?
Chronic kidney disease
End-stage renal disease (last stage of CKD)
What common investigations are used to diganose nephrotic syndrome and their typical findings?
Bedside:
Urine dipstick: Proteinuria
Urinalysis: Cellular casts, raised urine albumin-creatinine ratio
Bloods:
FBC
Creatinine and U&Es: Assess renal function
Lipid profile: Show elevated total and LDL cholesterol
LFT and serum albumin: Check for hypoalbuminaemia
Other tests depending on if secondary cause is suspected: e.g. Serum free light chains and urine protein electrophoresis, HIV test
Invasive/imaging:
Renal biopsy: Indicated in all adults
Why are renal biopsies rarely used when determining the cause for nephrotic syndrome in children?
The majority of causes of nephrotic syndrome in children are due to minimal change disease so they should be treated first and then consider a biopsy if treatement is inneffective to determine rarer causes.