Nephrotic Syndrome Lecture Powerpoint Flashcards
Mike oof
Nephrotic syndrome definition
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
When albumin leaks into urine, the blood loses ____ pressure, which can result in ___
Plasma osmotic, edema
Normal urinary protein excretion should be less than ___mg/day
150
Common causes of transient proteinuria (3)
- Exercise
- Fever
- UTI
Persistent proteinuria definition
Protein excretion greater than 150mg/day on 2 more more occassions
A positive urinalysis for proteinuria indicates urinary protein excretion above ___mg/day. A urine dipstick only measures what protein?
300, albumin
Nephrotic syndrome range is when proteinuria loss is greater than ___mg/day
3500
3 symptoms of nephrotic syndrome
- hyperlipidemia
- hypoalbuminemia
- edema of legs feet and ankles
Orthostatic proteinuria definition, how do we test for it?
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
Nephrotic range proteinuria test and confirmatory diagnostic test
24 hr urine sample, diagnosis confirmed by a kidney biopsy
Primary vs secondary nephrotic syndrome
Primary has an absence of identifieable systemic disease
Secondary has presence of identifiable systemic disease causing damage to the kidneys (diabetes, SLE, amyloidosis)
6 sources that account for 90% of nephrotic syndrome
- minimal change disease (childhood onset)
- Focal segmental glomerulosclerosis
- membranous glomerulopathy
- membranoproliferative glomerulonephritis
- diabetic neuropathy (most common in US)
- amyloidosis
Minimal change disease accounts for majority of cases of nephrotic syndrome in this population
Children under 10
Minimal change disease symptoms (3)
- Severe edema
- ascites
- pleural effusions (crackles heard on PE)
Minimal change disease pathophysiology
Often idiopathic, potentially immunologically mediated and related to abnormal T cell function
Minimal change disease treatment and prognosis
Corticosteroid therapy, excellent prognosis
Focal segmental glomerulosclerosis (FSGS) definition
Scarring of the glomeruli of the kidney resulting in decreased renal function and eventually failure
Focal segmental glomerulosclerosis treatment and prognosis
Corticosteroids, very poor, high rate of progression to end stage renal disease
Membranous nephropathy definition, what disease is it most commonly associated with?
-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
What does the sediment of centrifuge urine contain?
- RBCs
- WBCs
- RBC casts
- Lipids
- WBC casts
Membranoproliferative glomerulonephritis definition, typical presentation (what do we see in sediment?)
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
1 systemic disease causing nephrotic syndrome
Diabetic glomerulosclerosis
Treatment for nephrotic syndrome induced edema cannot be treated by just adding more fluids. Why?
-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
Why is hypothyroidism seen in nephrotic syndrome? Why does nephrotic syndrome put an individual at risk for infection? Why is it a hypercoaguable state?
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
Frothy urine even aftersitting for a period of time is indicative of…
…high proteinuria and potentially nephrotic syndrome
Nephrotic syndrome hyperlipidemia (oval fat bodies) mechanism of action
Decreased oncotic pressure and hypoalbuminemia causes increased hepatic synthesis of proteins and lipids concurrent with decreased peripheral metabolism
Nephrotic syndrome may lead to metabolic ___
alkalosis
BMP vs CMP
A CMP includes the 7 components of a BMP and liver function tests
Serum creatinine will not be a good marker for gross renal function in ___ renal impairment
early
Azotemia definition
Higher than normal level of blood urea nitrogen, might be indicative of kidney’s inability to excrete these compounds
Membranous glomerulopathy treatment
Corticosteroids
What drugs should be avoided in the treatment of nephropathies
- ASA
- NSAIDS
- certain antibiotics
Edema dietary management
Decrease Na+
fluid restriciton if hyponatremic
Decrease fat
Adequate protein in diet
If patient is diabetic, avoid prednisone or adjust doage because it can cause…
…elevated blood sugar levels
Drug indicated for nephrotic syndrome treatment
Prednisone
