L3: Nephrotic Syndrome

Question 1

Def of Nephrotic syndrome

Answer 1

Question 2

Etiology of Nephrotic syndrome

Answer 2

• Primary (idiopathic)
• Secondary

Question 3

Etiology of Nephrotic syndrome

• Primary

Answer 3

…

Question 4

Etiology of Nephrotic syndrome

• Secondary

Answer 4

Question 5

Etiology of Nephrotic syndrome

• Amyloid Nephropathy

Answer 5

▪ Multiple myeloma (AL amyloidosis) OR

▪ Chronic inflammatory disease as rheumatoid arthritis (AA amyloidosis).

Question 6

CP of Nephrotic syndrome

Answer 6

• Proteinuria
• Hypoalbuminemia
• Edema
• Hyperlipidemia
• Lipoiduria
• Others (HTN & Hypo K & Ca)

Question 7

CP of Nephrotic syndrome

• Proteinuria

Question 8

Proteinuria in Nephrotic Syndrome

• Pathogenesis

Answer 8

① Damage to the endothelial surface, the glomerular basement membrane, or the podocytes.

② Loss of glomerular membrane negative charges causing albuminuria (as albumin has a net negative charge).

Question 9

Proteinuria in Nephrotic Syndrome

• Presentation

Answer 9

frothy (foamy) urine due to proteins in urine.

Question 10

Hypoalbuminemia in Nephrotic Syndrome

• Pathogenesis

Answer 10

① Most of albumin loss is due to urinary excretion.

② A substantial fraction of the filtered albumin is taken up by and catabolized in the proximal tubular cells.

③ Liver compensatory mechanism appears to be blunted in nephrotic syndrome

Question 11

Edema in Nephrotic Syndrome

Answer 11

Question 12

Edema in Nephrotic Syndrome

• Pathogenesis

Answer 12

Question 13

Edema in Nephrotic Syndrome

• Characters

Answer 13

▪ In the beginning, it develops around the eyes and legs.

▪ Over time, the edema becomes generalized and leads to increasing weight and the development of ascites or pleural effusions.

Question 14

Hyperlipidemia in Nephrotic Syndrome

Answer 14

Question 15

Hyperlipidemia in Nephrotic Syndrome

• two most common lipid abnormalities in the nephrotic syndrome

Answer 15

▪ Hypercholesterolemia (mainly ⮅ LDL)

▪ Hypertriglyceridemia.

Question 16

Hyperlipidemia in Nephrotic Syndrome

• Pathogenesis

Answer 16

Question 17

Lipiduria in Nephrotic Syndrome

Answer 17

Accumulations of lipid in cellular debris and casts

Question 18

BP & Electrolytes in Nephrotic Syndrome

Answer 18

• Hypertension: may occur but more common in nephritic syndrome.
• Electrolytes: Hypokalemia & Hypocalcemia (pseudo or true).

Question 19

Complications of Nephrotic Syndrome

Answer 19

Question 20

Complications of Nephrotic Syndrome

• Negative nitrogen balance

Answer 20

• Loss in lean body mass with often occurs in patients with marked proteinuria (may be masked by weight gain due to concurrently increasing edema).

Question 21

Complications of Nephrotic Syndrome

• hypovolemia

Answer 21

…

Question 22

Complications of Nephrotic Syndrome

• Hypercoagulability & thromboembolism

Answer 22

particularly deep vein & renal vein thrombosis

Question 23

Complications of Nephrotic Syndrome

• Infection

Answer 23

particularly with encapsulated bacteria as streptococcus pneumonia

Question 24

Complications of Nephrotic Syndrome

• AKI

Answer 24

mostly pre-renal AKI due to hypovolemia

Question 25

Complications of **Nephrotic Syndrome** - CKD

Answer 25

◈ Most causes are associated with progressive kidney failure with the exception of MCD. ◈ The risk increases in proportion to the severity of the proteinuria.

Question 26

Dx of **Nephrotic Syndrome**

Answer 26

- urine Studies - Labs - Bx

Question 27

Dx of **Nephrotic Syndrome** - urine Studies

Answer 27

Question 28

Dx of **Nephrotic Syndrome** - Labs

Answer 28

Question 29

Labs in **Nephrotic Syndrome**

Answer 29

Question 30

Labs in **Nephrotic Syndrome** - KFTs

Answer 30

usually normal in uncomplicated cases.

Question 31

Labs in **Nephrotic Syndrome** - Serum Albumin

Answer 31

< 3.5 g/dl

Question 32

Labs in **Nephrotic Syndrome** - Lipid Profile

Answer 32

hyperlipidemia

Question 33

Labs in **Nephrotic Syndrome** - electrolytes

Answer 33

Decreased K+ & total Ca++ .

Question 34

Labs in **Nephrotic Syndrome** - Serology

Answer 34

▪ Tests for infections (e.g., HBV - HCV – HIV). ▪ Tests for Lupus (e.g., ANA - anti-dsDNA). ▪ Complement.

Question 35

Biopsy in **Nephrotic Syndrome**

Answer 35

Question 36

Biopsy in **Nephrotic Syndrome** - In Peds?

Answer 36

- we often use an initial empiric trial of glucocorticoids because of the high incidence of MCD.

Question 37

Biopsy in **Nephrotic Syndrome** - In Adults

Answer 37

Biopsy is usually indicated to: ▪ Confirm the diagnosis ▪ Offer prognosis ▪ Inform management decisions

Question 38

TTT of **Nephrotic Syndrome**

Answer 38

Question 39

TTT of **Nephrotic Syndrome** - TTT of Cause

Answer 39

Treatment should be dictated by the type of renal pathology causing nephrotic syndrome.

Question 40

TTT of **Nephrotic Syndrome** - TTT of Proteinuria

Answer 40

Question 41

TTT of **Nephrotic Syndrome** - TTT of Edema

Answer 41

① Dietary sodium restriction. ② Diuretics (e.g., Loop).

Question 42

TTT of **Nephrotic Syndrome** - TTT of Hyperlipidemia

Answer 42

Question 43

TTT of **Nephrotic Syndrome** - Vaccination

Answer 43

All patients should receive pneumococcal vaccination.

Question 44

Done

Answer 44

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