Nephrotic syndromes Flashcards
What is nephrotic syndrome?
- Glomeruli damaged
- become more permeable
- plasma proteins pass from blood to nephron into urine= MASSIVE PROTEINURIA
What are the triad of features?
- Oedema
- Proteinuria (> 3.5 g/24 hours)
- Hypoalbuminaemia (< 30 g/L).
Why are these patients prone to thromboembolic complications?
Hypercoagulable
Due to losing antithrombin III proteins
Why are these patients at risk of infections?
Due to loss of immunoglobulins through urine
Why is urine frothy?
Loss of lipids in urine
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
often idiopathic
can be triggered by recent infection, recent vaccination or by imm beune stimulua (e.g beesting)
What is effacement?
Direct damage to foot processes of the podocytes whereby they become flattened
This is causes by T cells in blood
Damaged foot processes lose negatively charged coat, allowing negative molecules, like albumin, to slip into the nephron
Minimal change disease
Selective proteinuria
Electron microscopy= shows effacement of podocyte foot processes
Treated with corticosteroids
Focal segmental glomerulosclerosis
- Most common cause of NS in African/Hispanic ind
- Usually history of heroin abuse, HIV, congenital malformations
- effacement of podocyte foot processes + scleroris & hyalinosis
- inconsistent response to steroids
- may progress to CKD
Membranous nephropathy
Can be primary or secondary (to SLE, Drugs, infections)
Occurs due to immune complexes targeting GBM
Poor response to steroids
-may progress to CKD
Diabetic glomerulonepthropathy
common cause of end stage renal failure
increase in GFR due to high pressure in glomerulus
How do you treat hyperkalaemia?
- Calcium gluconate IV stat
- Salbutamol 2.5mg nebuliser
- Intravenous insulin and glucose
Severe - Haemodialysis
- Haemofiltration
