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Gen Med Unit 4 > Nephrotic Syndromes > Flashcards

Nephrotic Syndromes Flashcards

1
Q

Definition of Nephrotic Syndrome

A
  1. Kidney diseasewith:
    - Proteinuria > 3g/day
    - Hypoalbuminemia <3g/dL
    - Edema
    - Hyperlipidemia
  2. HTN is common
  3. Bland urine sediment (few or no casts or cells)
  4. +/- oval fat bodies in urine
  5. Always involves injury to glomeruli
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2
Q

Nephritic syndrome

A

Nephritic associated with glomerular inflammation, hematuria, cellular casts & impaired kidney function

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3
Q

What can damage to the glomerular membrane lead to?

A
  1. Albuminuria

2. Proteinuria: leakage of all plasma proteins

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4
Q

Nephrotic syndrome Sxs

A 
1. Peripheral edema: 
Na+ retention & low albumin (<2 g/dL)
2. Dyspnea
3. Pulmonary edema
4. Pleural effusions
5. Ascites
6. Loss of Immunoglobulins: Increased infection risk
7. Loss of anticoag factors: 
Increased risk of thrombosis
8. (Asymptomatic in subnephrotic range proteinuria)
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5
Q

Primary Nephrotic Glomerular disease

A

Disease specific to the kidneys

  1. Minimal Change Disease
  2. Focal Glomerular Sclerosis
  3. Membranous Nephropathy
  4. Membranous Proliferative Glomerulonephritis
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6
Q

Secondary Nephrotic Glomerular Disease

A
  1. Renal manifestation of a systemic general illness :
    - Diabetes Mellitus:
    Most common cause in US
    -Systemic Lupus Erythematosus (SLE)
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7
Q

How frequent is minimal change disease in different age groups?

A
  1. Children (80%), birth to 18 years

2. 20-25% of adult cases >40

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8
Q

What conditions can minimal change disease be secondary to?

A
  1. NSAID use
  2. Allergic reactions
  3. Tumors (Hodgkin’s Dz)
  4. Vaccinations
  5. Viral infections
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9
Q

Minimal Change Disease Sxs

A
  1. Foamy appearance of the urine
  2. Poor appetite
  3. Edema (periorbital, feet, ankles, abdomen)
  4. Weight gain (fluid retention)
  5. Does not reduce the amount of urine produced
  6. Rarely progresses to kidney failure
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10
Q

Minimal Change Disease Diagnostic studies results

A
  1. High cholesterol
    - Hypoproteinemiastimulatesprotein (including lipoprotein)synthesisby the liver
  2. High levels of proteinuria
  3. Low serum albumin
  4. Immunofluorescence exam of the biopsied kidney tissue will be negative
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11
Q

Why is a renal us performed in minimal change disease?

A

To determine if patient has two normal kidneys

To determine if there is intrarenal fibrosis

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12
Q

What are the indications for renal biopsy in general nephrotic syndrome?

A
  1. Nephrotic syndrome of unknown origin
  2. Not indicated in DM
  3. Diagnostic for minimal change disease: Done if steroid-resistant or freq. relapse
  4. Never performed if there is only one functioning kidney
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13
Q

Minimal Disease Tx for Children

A
  1. Corticosteroids can cure most cases (Tx up to 16 weeks)

2. Some may need to stay on steroids to keep the disease in remission

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14
Q

Minimal Disease Tx for Adults

A
  1. Do not respond to steroids as well as children, but many still find steroids effective
  2. May have more frequent relapses and become dependent on steroids
  3. 3 or more relapses-
    Cytotoxic therapy (cyclophosphamide/Cytoxan)
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15
Q

Other tx for Minimal change disease

A 
1. Diuretics:
Increase urine output
2. Anticoagulation:
Nephrotic pt’s have ↑ loss of antithrombin, Protein C, & Protein S; also have ↑ platelet activation
3. Proper nutrition: 
1-2 g/kg/day protein
Low Na+ diet
4. ACE Inhibitors:
Lower efferent arteriole resistance out of proportion to afferent arteriole resistance  ↓ glomerular pressure  ↓ kidney damage  ↓ urinary protein loss
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16
Q

What is the most common cause of ERSD in the US?

A

Diabetic neuropathy

17
Q

What are risk factors for diabetic neuropathy?

A
  1. Hx of DM
    Type I @ 30-40% risk after 20 yrs
    Type II @15-20% risk after 20 yrs
18
Q

1st stage of Diabetic Neuropathy

A

Hyperfiltration with increased GFR

19
Q

2nd Stage Diabetic Neuropathy

A

Microalbumuria (30-300 mg/d)

20
Q

3rd stage daibetic neuropathy

A
  1. Macroalbunuria (>300 mg/d)
  2. GFR declines
  3. Glomerulosclerosis
  4. Kidney hypertrophy
21
Q

What are some renal complications from diabetic neuropathy?

A
  1. Papillary necrosis
  2. Chronic interstitial necrosis
  3. Renal tubular acidosis
  4. Renal injury from IV contrast dyes, NSAIDs
22
Q

Tx for diabetic neuropathy

A
  1. Treat CV risk factors
  2. Strict glycemic and BP control: ACE inhibitors or ARB’s to Slow progression to ESRD, Reduce intraglomerular pressure. BP goal 130/80 (120/75 if high microalbumin)

Gen Med Unit 4 (7 decks)

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