Nephrotic vs Nephritic

Question 1

What is the triad of signs in NephrOtic syndrome?

Answer 1

proteinuria >3g/24hrs (P:Cr >300mg/mol)
Hypoalbuminaemia (<30g/L)
oedema- generalised pitting oedema

Question 2

what are some primary renal disease causes in nephrotic syndrome?

Answer 2

minimal change disease, membranous nephropathy, focal segmental glomerulosclerosis, membranoproliferazive glomerulonephritis

Question 3

what are some secondary causes of nephrotic syndrome?

Answer 3

DM, SLE, Myeloma, amyloid and pre-eclampsia

Question 4

describe the pathophysiology of nephrotic syndrome

Answer 4

podocyte pathology leads to proteinuria

Question 5

how do you manage nephrotic syndrome?

Answer 5

fluid and salt restriction and diuresis with loop diuretics (furosemide) to decrease oedema
treat underlying cause e.g. steroids in minimal change disease
use ACEi and ARBs to decrease proteinuria.

Question 6

What are some complications of nephrotic syndrome?

Answer 6

thromboembolism (increased clotting factors), infection and hyperlipidaemia

Question 7

what signs would you expect in nephritic syndrome?

Answer 7

haematuria
small amount of proteinuria
mild HTN
decreased urine vol <300ml/day

Question 8

What are the 3 types of rapidly progressive glomerulonephritis?

Answer 8

Type 1: anti-GBM (goodpasture’s)
Type 2: immune complex deposition
Type 3: Pauci immune

Question 9

What are the causes of nephritic syndrome?

Answer 9

Proliferative/post streptococcal

Crescenteric/rapidly progressive glomerulonephritis

Question 10

Who usually gets proliferative glomerulonephritis?

Answer 10

Children and young adults

Question 11

What is the treatment for type 1 rapidly progressive glomerulonephritis (anti GBM (goodpasture’s))?

Answer 11

Plasmapheresis and immunosuppression

Question 12

What are the 3 presentations of glomerulonephritis?

Answer 12

Asymptomatic haematuria
Nephrotic syndrome
Nephritic syndrome

Question 13

When someone says Bence-Jones proteins what condition do you think of?

Answer 13

Multiple myeloma

Question 14

Name some investigations you would do if you suspect glomerulonephritis?

Answer 14

Bloods : FBC, U+Es, ESR, complement c3 and c4, antibodies ANA, dsDNA, ANCA, GBM

URINE: dipstick for protein and blood
MCS
Bence Jones proteins

Imaging: CXR ( Goodasture’s, Wegener’s)
Renal USS+/- biopsy

Question 15

What is the general management of glomerulonephritis?

Answer 15

Refer to nephrologist 
Aggressibe BP (HTN) management (<130/80)

Question 16

What are the 3 main features of nephrotic syndrome?

Answer 16

proteinuria
hypoalbuminaemia
oedema (due to the reduced oncotic pressure from the hypoalbuminaemia)

Question 17

where might you get oedema in nephrotic syndrome?

Answer 17

periorbital, genital, ascites, peripheral

Question 18

what effect does nephrotic syndrome have on the liver?

Answer 18

as there is proteinuria there is hypoproteinaemia. as a result the liver increases its production of proteins such as coagulation proteins and lipoproteins causing hypercoagulabilty and hyperlipidaemia

Question 19

what are some of the complications of nephrotic syndrome?

Answer 19

VTE
Hyperlipidaemias
infection due to decreased immunoglobulins and complement

Question 20

describe the management of nephrotic syndrome

Answer 20

monitor U+Es, BP, fluid balance and wt
treat underlying cause
symptomating treatment: oedema–> fluid restrict and furosemide
proteinuria: ACEi/ARBs reduce proteinuria
Hyperlipidaemias–>statins
VTE- VTE prophylaxis
Treat HTN

Question 21

what are the 4 types of nephrotic syndrome?

Answer 21

1. minimal change glomerulonephritis
2. membranous nephropathy
3. focal segmental glomerulosclerosis
4. membranoproliferative/ mesangiocapillary glomerulonephritis

Question 22

what is the commonest cause of nephrotic syndrome on children?

Answer 22

minimal change glomerulonephritis

Question 23

what is the commonest cause of nephrotic syndrome in adults?

Answer 23

membranous nephropathy

Question 24

which cause of nephrotic syndrome is more common in afrocarrlibean people?

Answer 24

focal segmental glomerulosclerosis

Question 25

What is minimal change glomerulonephritis associated with?

Answer 25

URTI

Question 26

what is the treatment of minimal change glomerulonephritis?

Answer 26

steroids (short courses)

Question 27

what is the treatment for membranous nephropathy?

Answer 27

immunosuppression if renal function declines

Question 28

what is the treatment for focal segmental glomerulosclerosis?

Answer 28

steroids or cyclophosphamide/ciclosporin

Question 29

what are the 3 broad causes of proteinuria?

Answer 29

1 increased plasma levels e.g. myeloma and rhabdomyolysis
2 reduced tubular reabsorption e.g. fanconi syndrome
3 filtration leak–>glomerulonephritides

Question 30

What are the 3 causes of asymptomatic haematuria?

Answer 30

IgA nephropathy
Thin BM
Alport’s

Question 31

What is the commonest cause of primary glomerulonephritis in adults in the developing world?

Answer 31

IgA nephropathy

Question 32

Biopsy result: diffuse mesangial cell proliferation and mesangium IgA deposition
whats the diagnosis?

Answer 32

IgA nephropathy

Question 33

how does IgA nephropathy presentment?

Answer 33

episodic macroscopic haematuria occurring a few days after an URTI.

Question 34

what are some associated conditions with IgA nephropathy?

Answer 34

Coeliac’s disease, cirrhosis and dermatitis herpetiformis

Question 35

What is the treatment for IgA nephropathy?

Answer 35

steroids and if poor renal function give cyclophosphamide

Question 36

what is thin basement membrane disease?

Answer 36

it is an autosomal dominant disease which is a benign cause of persistent asymptomatic microscopic haematuria

Question 37

what is Alports syndrome?

and what are its features?

Answer 37

85% X linked recessive therefore in females it causes haematuria only but in males it causes hameaturia, proteinuria leading to progressive renal failure. other features include bilateral sensorineural hearing loss, lens discolouration and cataracts, retinal “flecks”