W1L6 Nephrotic Syn

Question 1

Definition Nephrotic Syndrome?

Answer 1

A syndrome characterized by:

1. Heavy proteinuria (> 3.5 gm/1.73 m2/d)
2. Massive oedema
3. Hypoalbminaemia
4. Hyperlipidaemia

Question 2

Etiology of Nephrotic Syndrome?

Answer 2

1- Primary(idiopathic) NS
2- Secondary NS
-Post infection -Drug induced
-Metabolic -Malignancy
-Pregnancy -Renal vein thrombosis.
-Congenital

Question 3

Pathology of Nephrotic Syndrome?

Answer 3

• Minimal change nephritis
• Membranous GN
• Proliferative GN
• Mesangial proliferative
• Mesngiocapillary
• Crescentic GN
• IgA nephropathy

Question 4

Clinical Features of NS

Answer 4

• Oedema
• Hypertension
• Anorexia, loss of appitite, pallor
• Manifestations of etiologic cause
• Manifestations of complications

Question 5

Complications of NS

Answer 5

• Subnutritional state.
• Infection.
• Premature atherosclerosis.
• Hypovolaemia.
• Drug related complications.
• Acute renal failure.
• Bone disease.
• Anaemia

Question 6

Investigations of Nephrotic Syndrome?

Answer 6

• Urine analysis proteinuria, microscopic hematuria, pyuria
• Blood analysis(creatinine, albumine & lipid)
• Investigations diagnosis of etiology 2ry NS (DM, SLE, malignancy)
• Kidney biopsy

Question 7

Treatment of NS?

Answer 7

• Ttt cause 2ry cases

- Ttt of complications

Question 8

Def edema?

Answer 8

• Accumulation abnormal amounts of fluids in interstitial spaces(water/ lymph)
• Escape/leakage of fluids from capillary vascular lumen to interstitial space

Question 9

Pathogenesis edema?

Answer 9

Forces controlling fluids in the capillary lumen and interstitial space:
1- Intra capillary hydrostatic force
2- Oncotic force created mainly by plasma proteins.
3- Capillary wall integrity.
4- Interstitial forces

Question 10

Mechanisms of oedema formation?

Answer 10

1-Increased hydrostatic forces(DVT, CHF)
2- Decreased oncotic forces (hypoprteinemia & liver cirrhosis)
3- Increased capillary wall permeability (burns, allergy)
4- Salt and water retention

Question 11

Types Of Oedema?

Answer 11

A- Petting or non-petting

B- Localized or generalized

Question 12

Causes edema?

Answer 12

1. Causes of non-petting (Lymphatic)edema:
   - elephantiasis(lower limbs)
2. Causes localized petting edema:
   - lower limb varicose veins, DVT
3. Causes of generalized oedema:
   - renal, hepatic, cardiac, pregnancy

Question 13

Features of Renal Oedema?

Answer 13

1- Presence stigmata of renal disease
2- Start buffness face then lower limb, ascites, pleural
3- Proteinuria, haematuria, SCr high

Question 14

Features Of Hepatic Oedema

Answer 14

1- Stigmata advanced hepatic disease
2- Ascites precede edema lower limb
3-Spindel shape(patient)
4- hypoalbunemia, low prothrombin time, high INR, normal urine

Question 15

Features Of Cardiac Oedema

Answer 15

1- Stigmata of cardiac disease
2- Oedema lower limbs that extend upward.
3- liver may be congested & tender, neck veins(congested & pulsating)
4- ECG & ECHOCAR (abnormal)