Renal: Nephrotic Syndrome Flashcards
What is the classic triad?
Proteinuria
Oedema
Low plasma albumin
What is the peak incidence in children?
Between 2 and 5 years
80% of cases are due to what condition?
Minimal change glomerulonephritis
Other than the 3 main features, what other features are there?
Hyperlipidaemia
Hypercoagulable state - due to loss of antithrombin III
Predisposition to infection - loss of protective immunoglobulins in urine
What clinical signs are there?
Periorbital oedema, especially on waking
Scrotal/ vulval oedema
Leg and ankle oedema
Ascites
Breathlessness due to pleural effusions and abdominal distension
Due to dyslipidaemia - xanthelasma, xanthomata
Frothy urine
What percentage have steroid sensitive nephrotic syndrome?
85-90%
The proteinuria resolves with corticosteroids
Do those with steroid sensitive nephrotic syndrome progress to CKD?
No
Who is it more common in?
Boys
Asians>Caucasians
Association with atopy
What type of infection is it often precipitated by?
Respiratory
What features suggest steroid sensitive nephrotic syndrome?
Age between 1-10 No macroscopic haematuria Normal BP Normal complement Normal renal function
How is steroid sensitive nephrotic syndrome managed?
Give oral steroids - prednisolone 60mg/m2 per day , after 4 weeks dose reduced to 40mg/m2 on alternate days for 4 weeks and then weaned and stopped
If the nephrotic syndrome does not respond to steroids, what should be done?
Renal biopsy - may be more complex diagnosis
How is steroid resistant nephrotic syndrome managed?
Management of oedema by diuretic therapy, salt restriction, ACEi and NSAIDS
What specific cells in the glomerulus are damaged?
Podocytes
Why does hypercholesterolaemia occur?
The low plasma albumin signals to the liver to work harder to produce more proteins and cholesterol
Why does the oedema occur?
Low plasma albumin causes low oncotic pressure - this means fluid moves into the interstitium causing oedema, and as a result a decrease in volume in the vascular compartment
Why does reduced GFR occur?
Due to the glomerular inflammation
And due to the reduced vascular volume - reduced CO and reduced renal perfusion.
The reduced GFR triggers renin production- activates RAS leading to sodium retention and consequently more water retention, further increasing the oedema
