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GI, liver, kidney > Nephrotic syndrome > Flashcards

Nephrotic syndrome Flashcards

1
Q

What typically presents with nephrotic syndrome

A

Non proliferative glomerulonephritis - glomerular damage + sclerosis

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2
Q

What is nephrotic syndrome

A

Heavy proteinuria >3.5g/day
Hypoabuminaemia 35g/L
Oedema

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3
Q

Non classical features typical of nephrotic syndrome that are still typical

A

Hyperlipidemia
Inreased risk of VTE/arterial thrombosis
Higher risk of infection
All due to protein loss

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4
Q

Primary nephrotic syndrome causes

A

Minimal change disease
Focal segmental glomeruloscelrosis
Membranous nephropathy

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5
Q

Secondary nephrotic syndrome causes

A

Diabetes mellitus
Amyloidosis
HIV

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6
Q

What causes the symptoms of nephrotic syndrome

A

Loss of protein principally albumin across lomeruli -> loss oncotic pressure + increased fluid in interstitial space

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7
Q

Symptoms of nephrotic syndrome

A

Fatigue
Poor appetite
Peripheral oedema
Periorbital oedema
SOB - effusions/oedema pulm
Foamy urine - excess protein

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8
Q

Signs of nephrotic syndrome

A

Oedena
Ascites
Effusions

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9
Q

Can AKI occurin nephrotic syndrome?

A

Yes but less common than in nephritic

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10
Q

Principal investigation for sus glomerular disease

A

Renal biopsy

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11
Q

What is normal for protein:creatinine urine ratio

A

<30mg/mmol

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12
Q

What is normal protein content over 24 hour urinary colelction

A

<0.2g

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13
Q

Blood tests for glomerular disease

A

FBC, U+Es. bone profile, HbA1c, ABG, lipid profile

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14
Q

What causes majority of nephrotic syndromes in children

A

Minimal change disease

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15
Q

What disease wuld show fusion of podocyte foot processes in electron micrscopy

A

minimal change disease

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16
Q

Diagnosis of minimal change disease

A

Children with nephrotic sydnrome - presumptive - initiate treatment and monitor response
Adults - renal biopsy

17
Q

Management of nephrotic syndroem

A

Systemic glucocorticoids eg prednisolone
Unresponsive -> further prednisolone causes or more intense immunosupressives

18
Q

What is focal segmental glomerulosclerosis

A

Sclerosis in at least one part of glomerulus
Primary, secondary or genetic

19
Q

what happens in focal segmental glomerulosclerosis - primary

A

circulating factor causes Foot process effacement - loss of podocyte foot process structure -> spread out, reduces filtration barrier efficacy

20
Q

Secondary focal segmental glomerulosclerosis what happens histologically

A

Adaptive response to renal injury usually ass with less significant proteinuria and renal impairment
Combo of glomerular hypertrophy (cell proliferation)+ hyperfiltration (abnormally high glomerular filtration rate)

21
Q

Cuases of secodnary focal segmental glomeruloscerosis

A

Severe obesity
Reflux nephopathy
Reduction in kidney mass 0 due to comensatory hyperfiltration in remaining kidney mass

22
Q

Diagnosis of focal segmental glomerulosclerosis

A

Renal biopsy
In childhood suggests genetic cause 22

23
Q

What is membranous nephropathy?

A

Glomerular basement membrane thickening in absence of significant cellular proliferation
Common in adults

24
Q

Primary membranous nephropathy cause

A

AI reaction against important antigens in filtration barrier
=> autoantibody deveolpment. immune deposits and thickening of GBM
PLA2R antibodies major cause

25
Q

Secondary membranous nephropahty

A

Underlying infection, drug use, systemic disorder context
SLE, viral hepatitis, prostate cancer, NSAID use

26
Q

Diagnosis of membranous nephropathy

A

Anti-PALR2 on bloods - primary with nephrotic syndrome
Renal biopsy

27
Q

Management membranous nephropathy

A

High risk disease progression - immunosupressants in primary MN
Secondary = underlying cause
Some may spontaneously resolve

28
Q

Renal amyloidosis what is

A

Deposition of amyloid fibrils in glomerulus -> nephrotic syndrome
AL or AA

29
Q

AL amyloidosis

A

Excess light chains - plasma cell disorders often malignancies

30
Q

AA amyloidosis

A

Excess precursor protein due to chronic inflammation

31
Q

Diagnosis of amyloidosis

A

Renal biopsy using congo red staining
Can be taken from anywhere as systemic

32
Q

How does amyloidosis look in congo red staining

A

apple green birefringence under polarised light

33
Q

Management of amyloidosis

A

AA, AL, hereditary
Supportive theraoy where renal involvement -> nephrotic syndrome
Severe end stage renal disease -> dialysis

34
Q
A

GI, liver, kidney (50 decks)

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