Nephrotic Syndrome & Systemic Illness

Question 1

Nephrotic Syndrome–Features

Answer 1

Proteinuria—(>3.5 g in 24 hrs)
Edema
Hypoalbinemia—(< 3.0)
Usually: Hyperlipidemia/hyperlipiduria
few cells or casts
[Glomerulopathy—proteinuria without the rest]

Question 2

Nephritic Syndrome–Features

Answer 2

Hematuria—RBC casts
Oliguria
Azotemia
HTN

Question 3

Lipids: Loss of cholecalciferol binding globulin results in

Answer 3

No vitamin D
decrease in calcium
increases PTH

Question 4

Nephrotic Syndrome: Minimal Change Disease:

Answer 4

Accounts for 90% of disease in children
Can occur in adults secondary to use of NSAIDS
Find only mild mesangial cell proliferation, no immune deposits and effacement of epithelial cell foot processes

Question 5

Nephrotic Syndrome: Focal Segmental Glomeruloslerosis (FSG):

Answer 5

Most common lesion found in those with idiopathic nephrotic syndrome 35% of the time [Blacks—50%]
Characterized by the presence in SOME glomeruli of segmental areas of mesangial collapse & sclerosis
Can be primary and secondary forms

Question 6

Proteinuria Treatment

Answer 6

ACE inhibitors/ARBs
Serum Cr and K+ level should be carefully monitored because these decrease the intraglomerular pressure
Protein restriction NOT recommended as evidence is unclear about usefulness and because protein losses are so heavy the patient may have malnutrition

Question 7

Amyloidosis

Answer 7

A group of diseases characterized by the deposition of proteins (amyloid) in organs leading to their destruction and ultimately the death of the patient

Question 8

Renal amyloidosis:

Answer 8

Primary:
Deposition of light chain Ig—AL
Deposition of heavy chain Ig—AH

Secondary—AA
Primarily autoimmune disorders
Some cancers

PP: amyloid deposition in the mesangium than the capillary loops

Question 9

Treatment of Diabetic Nephropathy

Answer 9

Tight glycemic control
Good BP control with an ACEI or ARB (not both together*)
Sometimes Na+ restriction/addition of a diuretic
Weight loss if obese
Control of hyperlipidemia

Question 10

Tuberculosis

Answer 10

Classic renal manifestation of TB is the presence of microscopic pyuria with a sterile urine culture – STERILE PYURIA
Urine cultures are the “gold standard”
Do first-morning, mid-stream voided specimens for 3-6 cultures
Tx with TB meds