Urology - Nephrotic and Nephritic Syndrome

Question 1

When does nephrotic syndrome occur?

Answer 1

Basement membrane in glomerulus becomes highly permeable to protein

Common between 2-5 years old

Question 2

What is the classic triad of nephrotic syndrome?

Answer 2

Nephrotic

Proteinuria
Hypoalbuminaemia
Oedema

Question 3

How does nephrotic syndrome present?

Answer 3

Frothy urine - Proteinuria
Pallor - Hypoalbuminaemia
Oedema

Question 4

What 3 features occur in nephrotic syndrome?

Answer 4

Deranged lipid profile - high cholesterol, trigylcerides and LDLs
High BP
Hyper-coaguability

Question 5

What is the most common cause of nephrotic syndrome?

Answer 5

Minimal change disease

Over 90% of cases

Question 6

What are some secondary causes of nephrotic syndrome?

Answer 6

Focal segmental glomerulosclerosis
Membranoproliferative glomerulonephritis
Henoch schonlein purpura
Diabetes
Infection e.g. HIV, hepatitis, malaria

Question 7

Why does minimal change disease occur?

Answer 7

No clear cause or risk factors

Question 8

What is used to identify minimal change disease?

Answer 8

Renal biopsy and microscopy will not be able to detect any abnormalities

Urinalysis
Small molecular weight proteins
Hyaline casts

Question 9

How is minimal change disease managed?

Answer 9

Corticosteroids e.g. prednisolone

Good prognosis, can reoccur

Question 10

What is a key common presentation of nephrotic syndrome?

Answer 10

2-5 year old child
Oedema
Proteinuria
Low albumin

Question 11

How is nephrotic syndrome managed?

Answer 11

• High dose steroids
• Low salt diet
• Diuretics to treat oedema
• Albumin infusions
• Antibiotic prophylaxis

Question 12

How long are high dose steroids given for?

Answer 12

4 weeks and weaned over next 8 weeks

• 80% respond to steroids (steroid sensitive patients)
• 80% of steroid sensitive patients relapse at some point and need further steroids
• Patients that struggle to wean are steroid dependent
• Patients that don’t respond are steroid resistant

Question 13

What treatment is given in steroid resistant children?

Answer 13

ACEi and immunosuppressants e.g.
Cyclosporine
Tacrolimus
Rituximab

Question 14

What are the complications of nephrotic syndrome?

Answer 14

• Hypovolaemia - fluid leaks from intravascular space into interstitial space
• Thrombosis - proteins that prevent clotting lost in kidneys and liver responds to low albumin by producing pro-thrombotic proteins
• Infections - kidneys leak immunoglobulins, weakens capacity of immune system to respond
• Acute or chronic renal failure
• Relapse

Question 15

What does nephritis cause?

Answer 15

Inflammation of nephrons leads to :
- Reduced kidney function
- Haematuria
- Proteinuria, less than in nephrotic

Question 16

What are the two most common causes of nephritis in kids?

Answer 16

Post-streptococcal glomerulonephritis

IgA nephropathy

Question 17

When does post-streptococcal glomerulonephritis occur?

Answer 17

1-3 weeks after a b-haemolytic strep infection e.g. tonsillitis caused by strep pyo

Immune complexes get stuck in glomeruli and cause inflammation, this leads to acute loss of renal function causing AKI

Question 18

How is post-streptococcal glomerulonephritis managed?

Answer 18

Supportive

80% make full recovery

Some may need antihypertensives and diuretics for hypertension and oedema

Question 19

What is IgA nephropathy?

Answer 19

IgA deposits in nephrons of kidney cause inflammation

Renal biopsy shows IgA deposits and glomerular mesangial proliferation

Question 20

Who is typically affected by IgA nephropathy?

Answer 20

Teenagers or young adults

Question 21

How is IgA nephropathy managed?

Answer 21

Supportive treatment of renal failure

Immunosuppressant medications e.g. steroids and cyclophosphamide to slow progression of disease