part 1 Flashcards
What is nephrotic syndrome?
- kidney disorder characterized by:
- abnormal protein leak (proteinuria)
- hypoalbuminemia, hyperlipidemia
- edema (increased glomeruli permeability allows loss of albumin in urine)
- hypoproteinemia
- altered immunity
With nephrotic syndrome what does loss of protein equal?
loss of protein =
increased synthesis of lipids and decreased oncotic pressure =
edema and hypovolemia
Is nephrotic syndrome a specific disease?
no, its a clinical state
What is the treatment for nephrotic syndrome?
- corticosteroid and no added salt diet
- IV albumin, diuretics to decrease edema
What is the most common form of nephrotic syndrome?
MCNS: minimal change nephrotic syndrome
- is a primary disease
- primary cause is unknown
- most common form of nephrotic syndrome
- is steroid sensitive
- more common in males than females
MCNS
With MCNS fluid shifts from the plasma to the interstitial space. What does this cause?
hypovolemia
ascites
What is the pathophysiology of MCNS?
-abnormal permeability of glomeruli membrane —>
-increase in protein filtration —>
-serum proteins (mainly albumin) lost into the urine (proteinuria/albuminuria)
-proteinuria results in decrease in plasma oncotic pressure and edema —>
-fluid shifts into the interstitial spaces due to:
hypoalbuminemia
activation of RAAS
activation of ADH (enhances renal absorption of sodium)
-immunoglobulins lost (altered immunity) —>
-coagulation factors and platelets are altered (hyper coagulability) —>
-liver increases/stimulates synthesis of lipoprotein due to losing so much protein (hyperlipidemia)
When testing for MCNS and urine dip stick is done, what will this detect?
high albumin
What are the clinical manifestations of MCNS?
- edema over several weeks (weight gain)
- perorbital edema on waking: resolves during the day
- fluid shift to abdomen and lower extremities
- urine may be frothy or foamy
- pallor
- hypertension
- irritable
- decreased urine output
- malaise
- anorexia (due to protein loss in urine)
