Week 1 clinical relevance Flashcards
Nephrotic syndrome features
proteinuria
oedema
hypoalbuminaemia
What is the general cause of nephrotic syndrome?
glomerular disease
Prognosis of minimal change disease
remission with steroid treatment is the normal course
some may relapse
General measures to help nephrotic syndrome
salt and water restriction
diuretics
?anticoagulation
?statin
?ACE-i
If furosemide doesn’t help in oedema due to nephrotic syndrome, what can be tried next?
bumetanide
If bumetanide doesn’t help in oedema due to nephrotic syndrome, what can be tried next?
add 2nd diuretic - thiazide/thiazide-like
metolazone is preferred
What is sequential nephron blockade?
giving both loop diuretic (works on loop of henle_ and thiazide-like diuretic (works on distal tubule) to help reduce oedema in nephrotic syndrome
take both at same time
they work on different parts of nephron so should be more effective together
How can human albumin solution help in nephrotic syndrome?
helps reduce oedema
increases blood flow to kidneys to increase effect of diuretics that have been given
What type of BP is a more accurate measure of fluid status?
postural (lying and standing)
drops when standing suggests hypovolaemia
(body will often compensate when sat/lying down)
Nephrotic syndrome complications
infection (cellulitis/pneumococcal infection) - skin stretching from oedema, humoral immunity impaired as Igs are proteins which are lost in urine
venous thrombosis - impaired mobility, loss of anti-thrombin 3 and other proteins from clotting cascade in urine
hypercholesterolaemia - synthesised in liver, senses protein is low and makes more (but non-specific process)
Should nephrotic syndrome patients be given thromboprophylaxis?
yes
warfarin/LMWH
not DOACs as the interaction with proteins not known (and high proteinuria in nephrotic syndrome)
