Nephrotic Syndromes- MJ Flashcards
Nephrotic syndrome has significantly increased _____ ______ permeability
Basement membrane
What are the essential components of diagnosis of Nephrotic syndrome? (5)
- Urine protein excretion ≥ 3.5 g per 24 hours (LOTS of protein)
- Hypoalbuminemia (serum albumin < 3 g/dL)
- Bland urinary sediment
- Oval fat bodies may be seen
- Peripheral edema (significant, “tree trunk legs”)
- Hyperlipidemia
What is a hallmark finding of nephrotic syndrome?
peripheral edema
- initially presents in dependent areas of body- LE
- occurs when serum albumin is <2g
What are 2 signs/symptoms of nephrotic syndrome?
- Peripheral edema (hallmark finding)
- Dyspnea (pulmonary edema, pleural effusions, diaphragmatic compromise from ascites)
What is seen on urinalysis in nephrotic syndrome?
- Proteinuria (from alteration of GBM)
- Oval fat bodies (associated w/ hyperlipidemia- lipid deposits in sloughed renal tubular epithelial cells)
What is seen on microscopic exam of urinalisis, particularly relating to the proteinuria?
•sediment has few cellular elements or casts
What are 2 characteristic lab findings of nephrotic syndrome?
1. Decreased serum albumin (< 3g)
2. Total serum protein < 6 g
Blood chemistries in nephrotic syndrome:
Hyperlipidemia occurs in > ____% of those w/ early nephrotic syndrome
Why is this?
50%
inc. protein excretion–> oncotic pressure falls–> liver produces more lipids–> decreased clearance of VLDL–> hypertriglyceridemia
What 3 things can be deficient in nephrotic syndrome due to loss of binding proteins in the urine?
Vitamin D, zinc and copper levels
What should be considered in a patient with nephrotic syndrome regarding protein loss?
- Protein malnutrition (occurs w/ urinary protein loss >10g/d)
- Daily total dietary protein intake should replace losses through urinary excretion in order to avoid negative nitrogen balance
How would you treat edema in nephrotic syndrome
- Dietary salt restriction
- Thiazide and loop diuretics used frequently (combo therapy and high doses often required)
How do you treat hyperlipidemia in nephrotic syndrome? (2 ways)
- Dietary modifications and exercise should be advocated
- Aggressive pharmacologic therapy is often required (Statins)
Nephrotic syndrome:
When does a patient become hypercoagulable? Why does this happen?
- Hypercoagulable when serum albumin < 2g
- Urinary loss of antithrombin III, protein C, protein S
- Increased platelet activation
T/F: patients with nephrotic syndrome are prone to renal vein thrombosis and other venous thromboemboli because they can become hypercoagulable?
True
•Those with renal vein thrombosis, pulmonary embolus, or recurrent thromboemboli require anticoagulation indefinitely
What are the 3 types of nephrotic syndromes?
1. Minimal change Disease (MC kids)
2. Membranous nephropathy (MC adults)
3. Focal Segmental glomerulosclerosis (FSGS)
More common in kids or adults:
- Minimal change disease?
- Memranous nephropathy?
- Minimal change disease- Kids
- Memranous nephropathy- Adults
Pathogenesis of which disease?
- Exact pathogenesis unclear
- Increased glomerular permeability
- Foot process effacement (of podocytes)
Minimal Change Disease
20-25% of adults w/ nephrotic syndrome has which disease?
Minimal Change Disease
Is Minimal Change Disease MC in men or women?
- M=F in adults
- Boys > girls in children
What is the MC cause of primary nephrotic syndrome in adults?
Membranous Nephropathy
Which nephrotic syndrome?
- Idiopathic immune mediated glomerulopathy
- Immune complex deposition in glomerular capillary walls result in increased permeability
Membranous Nephropathy
Although the clinical presentation of Membranous Nephropathy is variable and often asymptomatic, what 2 things are classic for this?
Edema w/ frothy urine
People with Membranous Nephropathy have a high incidence of what?
Venous thromboembolism
(b/c they are hypercoagulable)
