FN: Nephrotic Syndrome Flashcards Preview

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Flashcards in FN: Nephrotic Syndrome Deck (50):
1

Triad

Proteinuria
Hypoalbuminaemia
Oedema
Hyperlipidaemia

2

Triad

Proteinuria
Hypoalbuminaemia
Oedema
Hyperlipidaemia

3

Proteinuria levels

PCR >300mg/mM or >3g/24hrs

4

Hypoalbuminaemia

5

Oedema

Periorbital
Genital
aScites
PEripheral - often intravascularly depleted with reduced JVP )cf. CFF)

6

Complications

Infection: reduced Ig, reduced complement activity
VTE: up to 40%
Hyperlipidaemia: raised cholesterol adn TG

7

Investigations

As for GN check lipids
Biopsy:
1. Biopsy all adults
2. Steroids 1st with children: mostly minimal change disease

8

Secondary to

Systemic disease
1. DM: glomerulosclerosis
SLE: membranous
Amyloidosis

9

Types

Minimal change glomerulonephritis
Membranous Nephropathy
FSGS
Membranoproliferative/Mesangiocapillary

10

Minimal change glomerulonephritis epi

Commonest in children

11

Minimal change glomerulonephritis assoc

URTI

12

Minimal change glomerulonephritis biopsy

normal light micro, fusion of podocytes on EM

13

Minimal change glomerulonephritis Rx

Steroids

14

Minimal change glomerulonephritis prognosis

1% ESRF

15

Membranous Nephropathy epi

20-30% of adult nephrotic syndrome

16

Membranous Nephropathy associations

Ca: lung, colon, breast
AI: SLE, thyroid disease
Infections: HBV
Drugs: Penicillamine, gold

17

Membranous Nephropathy biopsy shows

subepithelial immune complex depositis

18

Membranous Nephropathy Rx

immunosuppresion if renal failure declines

19

Membranous Nephropathy prognosis

40% spontaneous remission

20

FSGS ep

Commoner in Afro-caribeens

21

FSGS causes

Idiopathic or secondary : VUR, Bergers, SCD, HIV

22

FSGS biopsy

focal scarring, IgM deposition

23

FSGS Rx

Steroids or cyclophosphamide/ciclosporin

24

FSGS prognosis

30-50% ESRF (may recur in transplants

25

Membranoproliferative/Mesangiocapillary GN
epi
May fall into which category
Assoc
Prognosis

Rare
AMy be nephrotic (60%) or nephritis(30%)
Association with HBV, endocarditis
Prognosis is 50% ESRF

26

Management general of nephrotic syndrome

Monitor U+E, fluid balance and weight
Treat the underlying causes
Symptomatic/Complications RX:
1. Oedema: salt and fluid restrict + frusemide
2. Proteinuria: ACEi/ARA reduced proteinuria
3. Stains
4. WTE prophylaxis: tinzaparin
5. Rx HTN

27

Proteinuria levels

PCR >300mg/mM or >3g/24hrs

28

Hypoalbuminaemia

29

Oedema

Periorbital
Genital
aScites
PEripheral - often intravascularly depleted with reduced JVP )cf. CFF)

30

Complications

Infection: reduced Ig, reduced complement activity
VTE: up to 40%
Hyperlipidaemia: raised cholesterol adn TG

31

Investigations

As for GN check lipids
Biopsy:
1. Biopsy all adults
2. Steroids 1st with children: mostly minimal change disease

32

Secondary to

Systemic disease
1. DM: glomerulosclerosis
SLE: membranous
Amyloidosis

33

Types

Minimal change glomerulonephritis
Membranous Nephropathy
FSGS
Membranoproliferative/Mesangiocapillary

34

Minimal change glomerulonephritis epi

Commonest in children

35

Minimal change glomerulonephritis assoc

URTI

36

Minimal change glomerulonephritis biopsy

normal light micro, fusion of podocytes on EM

37

Minimal change glomerulonephritis Rx

Steroids

38

Minimal change glomerulonephritis prognosis

1% ESRF

39

Membranous Nephropathy epi

20-30% of adult nephrotic syndrome

40

Membranous Nephropathy associations

Ca: lung, colon, breast
AI: SLE, thyroid disease
Infections: HBV
Drugs: Penicillamine, gold

41

Membranous Nephropathy biopsy shows

subepithelial immune complex depositis

42

Membranous Nephropathy Rx

immunosuppresion if renal failure declines

43

Membranous Nephropathy prognosis

40% spontaneous remission

44

FSGS ep

Commoner in Afro-caribeens

45

FSGS causes

Idiopathic or secondary : VUR, Bergers, SCD, HIV

46

FSGS biopsy

focal scarring, IgM deposition

47

FSGS Rx

Steroids or cyclophosphamide/ciclosporin

48

FSGS prognosis

30-50% ESRF (may recur in transplants

49

Membranoproliferative/Mesangiocapillary GN
epi
May fall into which category
Assoc
Prognosis

Rare
AMy be nephrotic (60%) or nephritis(30%)
Association with HBV, endocarditis
Prognosis is 50% ESRF

50

Management general of nephrotic syndrome

Monitor U+E, fluid balance and weight
Treat the underlying causes
Symptomatic/Complications RX:
1. Oedema: salt and fluid restrict + frusemide
2. Proteinuria: ACEi/ARA reduced proteinuria
3. Stains
4. WTE prophylaxis: tinzaparin
5. Rx HTN

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