Nephrotic Syndrome Flashcards
(78 cards)
1
Q
A
2
Q
Def of Nephrotic Syndrome
A
3
Q
Incidence of Idiopathic Nephrotic Syndrome
A
- It is the most common form of childhood NS.
- Representing more than 90 percent of cases between 1 and 10 years of age and 50 percent after 10 years of age.
4
Q
Age in Idiopathic Nephrotic Syndrome
A
2:8 years
5
Q
Sex in Idiopathic Nephrotic Syndrome
A
Male 2 : Female 1
6
Q
Pathogenesis of Idiopathic Nephrotic Syndrome
- Mechanism of Glomerular Injury
A
- Circulating non-immune Factors
- Circulating immune Factors
- Mutations in podocyte or slit diaphragm proteins
7
Q
Mechanism of Glomerular Injury in Nephrotic Syndrome
- Circulating non-immune factors:
A
8
Q
Mechanism of Glomerular Injury in Nephrotic Syndrome
- Circulating immune factors:
A
9
Q
Mechanism of Glomerular Injury in Nephrotic Syndrome
- Mutations in podocyte or slit diaphragm proteins
A
10
Q
Pathogenesis of Idiopathic Nephrotic Syndrome
- Mechanism of Edema
A
11
Q
Mechanism of Edema in Nephrotic Syndrome
- Arterial Underfiling
A
- A reduction in plasma oncotic pressure induced by hypoalbuminemia would seem to favor the movement of fluid out of the vascular space into the interstitium and produce arterial underfilling.
12
Q
Mechanism of Edema in Nephrotic Syndrome
- Sodium retention
A
- Sodium retention is due to increased reabsorption in the collecting tubules mainly due to increased activity of the Na-K-ATPase pump in the cortical collecting tubule and relative resistance to atrial natriuretic peptide.
13
Q
Pathogenesis of Nephrotic Syndrome
- Mechanism of hypoalbuminemia
A
14
Q
Pathogenesis of Nephrotic Syndrome
- Mechanism of Proteinurea
A
15
Q
Pathogenesis of Idiopathic Nephrotic Syndrome
- Mechanism of Hyperlipidemia
A
16
Q
CP of Nephrotic Syndrome
A
17
Q
CP of Nephrotic Syndrome
- Edema
A
18
Q
What is the major Presenting Symptom of Nephrotic Syndrome?
A
Edema
19
Q
Edema in Nephrotic Syndrome
- Manifestation
A
It becomes clinically detectable when fluid retention exceeds 3-5% of body weight.
20
Q
Edema in Nephrotic Syndrome
- Sites
A
- Periorbital edema frequently misdiagnosed as allergy is often the initial symptom.
- Edema is gravity dependent, localized to the lower extremities in the upright position, and to the dorsal part of the body in reclining position.
21
Q
Edema in Nephrotic Syndrome
- Characters
A
- This edema is soft and pitting, keeping the marks of clothes or finger pressure.
22
Q
Edema in Nephrotic Syndrome
- Severity
A
- Anasarca may develop with ascites, and pleural and pericardial effusions. (If anasarca occurred can’t be AGN)
- Edema of the scrotum and penis, or labia, may be seen.
23
Q
CP of Nephrotic Syndrome
- Abdominal Pain
A
- It may be related to rapid formation of ascites or concomitant hypovolemia.
- It is occasionally due to a complication such as peritonitis, thrombosis or rarely, pancreatitis.
24
Q
CP of Nephrotic Syndrome
- HTN
A
- Mild in 95% of cases.
- Blood pressure is usually normal but sometimes elevated.
25
CP of **Nephrotic Syndrome**
- Macroscopic Hematuria
It is observed in 3% of cases.
26
CP of **Nephrotic Syndrome**
- Complications
The disease may also be revealed by a complication
27
CP of **Nephrotic Syndrome**
- Asymptomatic
NS is occasionally discovered during a routine urine analysis.
28
Urine Analysis in **Nephrotic Syndrome**
- Volume
- Color
- Casts
- Specific Gravity
29
Investigations for **Nephrotic Syndrome**
- Urine Analysis
30
Investigations for **Nephrotic Syndrome**
- Urine & Blood
31
Urine Analysis in **Nephrotic Syndrome**
- Proteinuria
32
Qualitative Evaluation of Proteinuria in **Nehrotic Syndrome**
33
Quantitative Evaluation of Proteinuria in **Nehrotic Syndrome**
34
What is the screening test for Proteinuria in **Nephrotic Syndrome**?
Using urine dipstick
35
Urine Analysis in **Nephrotic Syndrome**
- Urine Protein Selectivity
36
Investigations for **Nephrotic Syndrome**
- Blood Tests
37
What is the Confirmatory test for Proteinuria in **Nephrotic Syndrome**?
- Using 24-hour urine protein
- Using Spot urine protein / creatinine ratio
38
Blood Tests for **Nephrotic Syndrome**
- CBC
- PTN
- Lipids
- C3
- Ck
39
Pathological Dx of **Nephrotic Syndrome**
40
When is Renal Bx Indicated in children in **Nephrotic Syndrome**?
41
Complications of **Nephrotic Syndrome**
- Infections
- Thromboembolism
- Hypovolemia
- Renal Insufficiency
- Corticosteroids SE
42
Most Common Complications of **Nephrotic Syndrome**
Infections
43
Bacterial Infections in **Nephrotic Syndrome**
- most Common Site
- The most common infection is peritonitis.
- Patients may also develop meningitis, pneumonia, UTI and cellulitis.
44
Bacterial Infections in **Nephrotic Syndrome**
- Organism
* Streptococcus pneumoniae "most common"
* Others: E. coli, streptococcus B, Haemophilus influenzae & other G-ve organisms
45
Complications in **Nephrotic Syndrome**
- Thromboembolism
46
Most Dangerous Complication in **Nephrotic Syndrome**
Thromboembolism
47
Thromboembolism in **Nephrotic Syndrome**
- Sites
- Both arterial and venous thromboses have been reported.
- Most common: pulmonary artery, renal vein, deep leg veins, inferior vena cava, and femoral/iliac artery.
- Others: cerebral and meningeal arteries, mesenteric and hepatic veins.
48
Complications in **Nephrotic Syndrome**
- Renal Insufficiency
49
TTT Aspects of **Nephrotic Syndrome**
- General
- Specific
50
General TTT of **Nephrotic Syndrome**
- Diet
51
General TTT of **Nephrotic Syndrome**
- Bed Rest
Noooo "cause thrombosis"
52
General TTT of **Nephrotic Syndrome**
- Edema
53
General TTT of **Nephrotic Syndrome**
- Hypovolemia
54
General TTT of **Nephrotic Syndrome**
- Prevention of Complications
55
Prevention of Complications in **Nephrotic Syndrome**
- Infections
- S pneumonia: Oral penicillin + Pneumococcal vaccine
- Varicella: Acyclovir + Varicella vaccine
56
Prevention of Complications in **Nephrotic Syndrome**
- Thromboembolism
57
Prevention of Complications in **Nephrotic Syndrome**
- Hyperlipidemia
It is reasonable to consider a lipid lowering regimen in children with a persistent NS
58
Specific TTT of **Nephrotic Syndrome**
- DOC
- Oral steroids: Corner stone
- The commonly used preparation is prednisone.
59
Specific TTT of **Nephrotic Syndrome**
- TTT of First Episode
60
Indications of Empiric TTT of **Nephrotic Syndrome** with Corticosteroids
61
TTT of First Episode in **Nephrotic Syndrome**
- Monitoring
Once a patient responds to steroid therapy, monitoring for proteinuria is required to detect relapses early.
62
Def of **Relapse** in Nephrotic Syndrome
Appearance of significant proteinuria (>40 mg/h/ m2 or >50 mg/kg/day or Albustix +++) for 3 consecutive days after having been in remission.
63
Patients who respond to steroid have one of the following courses:
64
Treatment of frequent relapsing/ steroid dependent NS:
65
Treatment of steroid resistant NS (SRNS)
- Due to Genetic Disorder
66
Treatment of steroid resistant NS (SRNS)
- Not Due to Gentic Disorder
- ACEI and ARB are used.
- Immunosuppressive therapy depends on the underlying pathology.
67
What are Examples of **Steroid Sparing Agents**?
- Levamisole
- Cyclophosphamide
- Cyclosporine
- Myco-phenolate mofetil
68
Compare between Nephrotic & Nephritic Syndrome in terms of
- Strept inf
69
Compare between Nephrotic & Nephritic Syndrome in terms of
- Edema
70
Compare between Nephrotic & Nephritic Syndrome in terms of
- Oliguria
71
Compare between Nephrotic & Nephritic Syndrome in terms of
- HTN
72
Compare between Nephrotic & Nephritic Syndrome in terms of
- Hematuria
73
Compare between Nephrotic & Nephritic Syndrome in terms of
- Serum Albumin
74
Compare between Nephrotic & Nephritic Syndrome in terms of
- Serum Cholesterol
75
Compare between Nephrotic & Nephritic Syndrome in terms of
- C3 & C4
76
Compare between Nephrotic & Nephritic Syndrome in terms of
- ASO
77
Compare between Nephrotic & Nephritic Syndrome in terms of
- Proyeinuria
78
Compare between Nephrotic & Nephritic Syndrome in terms of
- Casts
