Nephrotic Syndrome - MD Flashcards
What happens when albumin leaks into urine?
Blood loses its ability to absorb extra fluid → EDEMA
What is the reference range for normal urinary protein excretion?
< 150 mg/d
What is the difference between transient and persistent proteinuria?
Transient → proteinuria on a single test (may be due to fever, exercise, UTI, etc..)
Persistent → proteinuria present on 2 or more occasions (needs evaluation)
What are the collection of symptoms that indicate kidney damage?
1) Proteinuria (>3.5 g/d)
2) Hyperlipidemia
3) Edema of legs, feet, ankles
4) Hypoalbuminemia
What are the most common etiologies of proteinuria?
1) Glomerular
- ↑ filtration of macromolecules → leaks across glomerular capillary wall
2) Overflow
- filtered load is increased to a level that exceeds the normal proximal re-absorptive capacity
What is the difference between primary and secondary nephrotic syndrome?
Primary → absence of identifiable systemic disease
Secondary → presence of identifiable systemic disease
What type of histopathology is the most common cause of nephrotic syndrome in children?
Minimal Change Disease (80%)
What is the cause of Minimal Change Disease, what are the S/S, and what is the Tx?
- No cause is found in most patients (immunologically mediated → abnormal T-cell function)
- Severe edema, ascites, pleural effusion, NSAIDs may cause
- Tx: Corticosteroid therapy
What are the causes of Focal Segmental Glomerulosclerosis?
- Idiopathic
- Secondary: reflux nephropathy, HIV, or heroin-associated nephropathy, sickle cell disease, obesity, late-stage focal glomerulonephritis
- Familial Inherited form of FSGS: African-american patients, Alport syndrome, nail-patella syndrome
What is the most common systemic disease causing nephrotic syndrome?
Diabetic glomerulosclerosis due to either DM Type I or Type II
What type of glomerulonephritis usually presents with mixed nephrotic and nephritic syndrome?
Membranoproliferative glomerulonephritis
-Presents with hematuria, RBC casts, lipiduria, (oval fat bodies), & nephrotic-range proteinuria
What are the clinical manifestations of Nephrotic Syndrome?
- Edema
- Proteinuria (>3.5 g/day)
- Hypoalbuminemia (<3.0 mg/dL)
- Associated hypertriglyceridemia/hypercholesterolemia
- All results in: edema, hypercoagulability, hypothyroidism, & anemia
What proteins are lost during Nephrotic Syndrome and what processes do their loss cause?
- Immunoglobulin → immunocompromised state
- Antithrombin III/Protein C&S → hypercoagulability
- EPO & transferrin → anemia
- Thyroxine-binding globulin → hypothyroid
- Cholecalciferol binding globulin → ↓ Vit D, ↓ Ca++, ↑ PTH
Why is there an increase in lipids in patients with Nephrotic Syndrome?
↓ oncotic pressure & hypoalbuminemia → ↑ hepatic synthesis of proteins and lipids with concurrent decreased peripheral metabolism
What is the significance of oval fat bodies?
oval fat bodies are markers for nephrotic range proteinuria
