Nephrotic syndrome

Question 1

What triad is nephrotic syndrome characterised by?

Answer 1

Proteinuria (> 3 g/24 hr)
Hypoalbuminaemia (< 30 g/L)
Oedema

Question 2

List 3 causes of primary nephrotic syndrome. Which are the most common causes of nephrotic syndrome in kids and adults?

Answer 2

Minimal change disease (KIDS)
Membranous nephropathy (ADULTS)
Focal segmental glomerulosclerosis

Question 3

List 3 symptoms of nephrotic syndrome

Answer 3

Swelling (due to hypoalbuminaemia)
Frothy urine
Symptoms of underlying cause/ complications

Question 4

List 4 signs of nephrotic syndrome

Answer 4

Oedema: periorbital, peripheral, genital
Ascites: fluid thrill, shifting dullness
FH of atopy (in those with minimal change glomerulonephritis)
FH of renal disease

Question 5

What urinary investigations should be taken nephrotic syndrome?

Answer 5

Urine dip 3+ proteins
24 hr urine protein or spot urine protein/ creatinine ratio >3g/g
Urine sediment microscopy

Question 6

What other investigations may be performed in nephrotic syndrome?

Answer 6

FBC
U+Es: increased ADH causes hypervol. hypernatraemia
Serum albumin <3g/dL
Clotting factors: urinary loss of anticoags= hypercoaguable state
Lipids: HIGH (inc. synth in liver)
Vit D: LOW: urinary loss
CRP/ ESR HIGH

Question 7

List 3 causes of secondary nephrotic syndrome

Answer 7

Diabetic nephropathy
Amyloidosis
Lupus nephritis

Question 8

List causes membranous nephropathy?

Answer 8

Primary: Idiopathic
Secondary: SLE, Hep B/C, Tumours, Drugs