Renal Flashcards
When to discuss with nephrologist in nephrotic syndrome?
- Hypertension
- Frank Haematuria
- Age: <1 year or >12 year
- Renal impairment
- Features of vasculitis (rash, arthropathy)
- Family history of systemic illness
- Low C3
- Steroid resistant (no response after 28d on pred)
- x2 relapses on pred or relapse <14 after stopping
Triad of nephrotic syndrome
Proteinuria, hypoalbuminaemia, oedema
What constitutes a relapse on urine dip in nephrotic syndrome?
> /= 2+ protein on urine dipstick for 3 consecutive days
Initial investigations in new nephrotic syndrome
Bedside: obs, BP, urine dip, urine MC&S, morning urinary protein:creatinine ratio
Bloods: FBC, U+Es, LFTs, CRP, cholesterol, C3 and C4, Hep B+C, VZV, ASOT
If atypical features: ANA, anti-dsDNA
General management of nephrotic syndrome (non-medication)
- Dietician involvement – needs low-salt, normal-protein diet
- Monitor and control fluid balance – need input/output charts, daily weights. Some patients need fluid restriction and diuretics.
- Monitor BP
3 major complications of nephrotic syndrome
Hypovolaemia (shock)
Infection - need prophylacitc penicillin, pneumococcal and influenza vaccine recommended. No live vaccines. If VZV or HSV need Ig + aciclovir
Thrombosis - hydration reduces risk
Parental education in nephrotic syndrome
- Sick day rules (steroids)
- Safety netting: urgently attend ward if abdo pain
- Urine dips: daily until remission, then twice weekly until tapering dose of steroids finishes
