Nephrotic Syndrome Lecture Powerpoint

Question 1

Nephrotic syndrome definition

Answer 1

Kidney disorder that causes excretion of too much protein in the urine resulting from damage to the glomeruli, with the predominant protein being found being albumin

Question 2

When albumin leaks into urine, the blood loses ____ pressure, which can result in ___

Answer 2

Plasma osmotic, edema

Question 3

Normal urinary protein excretion should be less than ___mg/day

Answer 3

150

Question 4

Common causes of transient proteinuria (3)

Answer 4

• Exercise
• Fever
• UTI

Question 5

Persistent proteinuria definition

Answer 5

Protein excretion greater than 150mg/day on 2 more more occassions

Question 6

A positive urinalysis for proteinuria indicates urinary protein excretion above ___mg/day. A urine dipstick only measures what protein?

Answer 6

300, albumin

Question 7

Nephrotic syndrome range is when proteinuria loss is greater than ___mg/day

Answer 7

3500

Question 8

3 symptoms of nephrotic syndrome

Answer 8

• hyperlipidemia
• hypoalbuminemia
• edema of legs feet and ankles

Question 9

Orthostatic proteinuria definition, how do we test for it?

Answer 9

A condition characterized often in children by increased protein excretion in the upright position, but normal protein excretion after periods of laying flat. 1st urine collection in the morning is the best way to test for it

Question 10

Nephrotic range proteinuria test and confirmatory diagnostic test

Answer 10

24 hr urine sample, diagnosis confirmed by a kidney biopsy

Question 11

Primary vs secondary nephrotic syndrome

Answer 11

Primary has an absence of identifieable systemic disease

Secondary has presence of identifiable systemic disease causing damage to the kidneys (diabetes, SLE, amyloidosis)

Question 12

6 sources that account for 90% of nephrotic syndrome

Answer 12

• minimal change disease (childhood onset)
• Focal segmental glomerulosclerosis
• membranous glomerulopathy
• membranoproliferative glomerulonephritis
• diabetic neuropathy (most common in US)
• amyloidosis

Question 13

Minimal change disease accounts for majority of cases of nephrotic syndrome in this population

Answer 13

Children under 10

Question 14

Minimal change disease symptoms (3)

Answer 14

• Severe edema
• ascites
• pleural effusions (crackles heard on PE)

Question 15

Minimal change disease pathophysiology

Answer 15

Often idiopathic, potentially immunologically mediated and related to abnormal T cell function

Question 16

Minimal change disease treatment and prognosis

Answer 16

Corticosteroid therapy, excellent prognosis

Question 17

Focal segmental glomerulosclerosis (FSGS) definition

Answer 17

Scarring of the glomeruli of the kidney resulting in decreased renal function and eventually failure

Question 18

Focal segmental glomerulosclerosis treatment and prognosis

Answer 18

Corticosteroids, very poor, high rate of progression to end stage renal disease

Question 19

Membranous nephropathy definition, what disease is it most commonly associated with?

Answer 19

-An often autoimmune reaction in the glomeruli’s basement membrane that results in decay in renal function, most commonly associated with nephrotic syndrome in adults

Question 20

What does the sediment of centrifuge urine contain?

Answer 20

• RBCs
• WBCs
• RBC casts
• Lipids
• WBC casts

Question 21

Membranoproliferative glomerulonephritis definition, typical presentation (what do we see in sediment?)

Answer 21

An abnormal antibody response where immune complexes build up in the basement membrane of the glomeruli causing damage
Typically see RBC casts, lipidemia, etc in the analysis

Question 22

1 systemic disease causing nephrotic syndrome

Answer 22

Diabetic glomerulosclerosis

Question 23

Treatment for nephrotic syndrome induced edema cannot be treated by just adding more fluids. Why?

Answer 23

-This won’t fix the pressure gradient that is missing as a result of proteinuria, it will just put strain on the heart and exacerbate the problem

Question 24

Why is hypothyroidism seen in nephrotic syndrome? Why does nephrotic syndrome put an individual at risk for infection? Why is it a hypercoaguable state?

Answer 24

Thyroid hormone leaves with the proteins out to the urine/periphery
Some immunoglobins are also lost to the periphery/urine
It involves a loss of antithrombin III, protein C causes a risk of hypercoaguability

Question 25

Frothy urine even aftersitting for a period of time is indicative of…

Answer 25

…high proteinuria and potentially nephrotic syndrome

Question 26

Nephrotic syndrome hyperlipidemia (oval fat bodies) mechanism of action

Answer 26

Decreased oncotic pressure and hypoalbuminemia causes increased hepatic synthesis of proteins and lipids concurrent with decreased peripheral metabolism

Question 27

Nephrotic syndrome may lead to metabolic ___

Answer 27

alkalosis

Question 28

BMP vs CMP

Answer 28

A CMP includes the 7 components of a BMP and liver function tests

Question 29

Serum creatinine will not be a good marker for gross renal function in ___ renal impairment

Answer 29

early

Question 30

Azotemia definition

Answer 30

Higher than normal level of blood urea nitrogen, might be indicative of kidney’s inability to excrete these compounds

Question 31

Membranous glomerulopathy treatment

Answer 31

Corticosteroids

Question 32

What drugs should be avoided in the treatment of nephropathies

Answer 32

• ASA
• NSAIDS
• certain antibiotics

Question 33

Edema dietary management

Answer 33

Decrease Na+
fluid restriciton if hyponatremic
Decrease fat
Adequate protein in diet

Question 34

If patient is diabetic, avoid prednisone or adjust doage because it can cause…

Answer 34

…elevated blood sugar levels

Question 35

Drug indicated for nephrotic syndrome treatment

Answer 35

Prednisone