SS3. Nephrotic syndrome - overview

Question 1

What is another word for nephrotic syndrome?

Answer 1

Glomerulungphritis

Question 2

How does nephrotic syndrome present itself?

Answer 2

Tetrad: proteinuria (>3,5/g/24h)
Dyslipidemia (hypercholesterolemia)
Hypoalbumenia
Pheripheral oedema

Question 3

What is the pathophysiology of nephrotic syndrome?

Answer 3

1) Inflammation/damage to podocytes in glomerulus, allows proteins to pass through nephrine tubules –> proteinuria, with or without blood
2) AB lost, with loss of immunoglobulin with increased risk of infections
3) mass loss of protein results in hypoproteinemia (less albumin in blood), so more proteins are made by liver such as hypercholesterol and albumin.
4) hyperproteinemia results in reduced plasma oncotic pressure, meaning that H2O and electrolytes move into intertestinum, resulting in oedema.
5) decrease of volume circulation results in venous return to the heart. Heart will be pumping less volume to rest of body –> decrease blood flow.
6) decreased blood flow stimulates cells to produce renin, resulting in increase of bp (angiotensin etc) –> retains H2O and Na+, resulting in further oedema.

Question 4

What are symptoms of nephrotic syndrome?

Answer 4

dyslipodemia (xanthelasma deposit of cholesterol in eye) xanthomata
Hypoalbuminaemia: tiredness, leukonychia
Peritombital oedema: ascites, breathlessness (pulmonary oedema, plural effusion)
Frothy urine

Question 5

What are common causes of nephrotic syndrome?

Answer 5

Diabetes

Immunological problems that affect kidneys.

Question 6

How is it diagnosed?

Answer 6

urine dipstick, blood assay, serum(urine) immunoglobins, autoimmune screen, chest xray to see pleural effusion and oedema. Ultrasound.
Renal biopsy (1) light microscopy general change.
2) Immunofluorescence, stain
3) electron miscoscopy, detailed change of glomerulus