Nephrotic Syndromes Flashcards
Presentations of nephrotic syndrome
Loss of protein –> oedema, frothy urine and recurrent infections
Increased liver synthesis–> hyperlipidaemia (due to an increase in production of lipoproteins and a decrease in lipase activity) and venous thromboses
Nephrotic syndromes are characterised by
Proteinuria (>3 g/24hr) + oedema + hypoalbuminaemia (<30g/L)
This is due to increased glomerular permeability which allows proteins thought but not red blood cells
Causes of nephrotic syndromes
In children–> minimal change nephropathy
In adults –> focal segmental glomerulosclerosis
Diabetic nephropathy
Membranous nephropathy (related to hep B and C)
Myeloma causing renal amyloidosis
Minimal change nephropathy
Commonest cause in children of nephrotic syndrome
Biopsy normal, often not required –> treat empirically with high dose steroids and monitor for improvement in proteinuria
Focal segmental glomerulosclerosis
Most common cause of nephropathy in adults
On biopsy there is focal nephrotic damage in a segment of the glomerulus causing leakage of proteins
Diabetic nephropathy
Occurs in type 1 or 2 with or without retinopathy or neuropathy
De to angiopathy of the glomerular capillaries causing nephrotic syndrome and diffuse glomerular sclerosis and nodules with a rim of surrounding cell
Membranous nephropathy
Major risk factor is Hep B and C
On biopsy there is generalised thickening of membranes
Renal amyloidosis
Most commonly due to myeloma–> Presents with severe bony pain
On biopsy there is dense protein in the mesangium, pinkness outside the cells (renal amyloidosis) and green birefringence on Congo red staining with polarised light
Management of nephrotic syndrome
Diagnose —> biopsy adults but first trial steroid in children (90% effective) and serological tests
Diuretics for oedema, anti-coagulate and reduce lipids to treat liver over action, ACEi for proteinuria, immunosuppression (if a bit nephritic) and treat underlying disease
