Nephrotic syndrome Flashcards
(21 cards)
How do you diagnose Nephrotic syndrome
Proteinuria >3.5g/day AND Hypoalbuminemia <25g/L AND edema
What are the most common causes of nephrotic syndrome in Singapore
- Minimal change disease
- Diabetic nephropathy
How does edema develop in nephrotic syndrome
- Loss of albumin in urine –> water move into tissue spaces –> less intravascular volume = less renal perfusion –> activation of RAAS –> more sodium and water retention
What are other primary idiopathic cause of nephrotic syndrome
- FSGS
- Membranous glomerulopathy
What are other secondary causes of nephrotic syndrome
- Autoimmune eg SLE
- Infection
- Malignancy
- Drugs
- Genetics
How do you manage oedema and hypertension in nephrotic syndrome
- Low salt diet <2g
- Fluid restriction
- Diuretics (frusemide/thiazide/K sparing)
How do you manage proteinuria
- ACE inhibitors or ARB
How do you manage hypoalbuminemia
- Increase dietary protein to 0.8-1kg/day + urine protein loss amount
How does the risk of thromboembolism increase
Loss of anti-coagulant proteins and increase in pro-coagulant factors (due to hypoalbumin that triggers liver to make them)
why are patients with nephrotic syndrome more prone to infections
Loss of igG from urine, reudced complement activity and T cell function
Why is hyperlipidemia a complication
Loss of proteins in urine = low oncotic pressure = stimulate hepatocytes to produce lipoproteins. Also have decreased clearance of lipoproteins and defect in triglyceride catabolism
How will infections appear in nephrotic syndrome
either as cellulitis due to the edema or pneumonia
What are the common complications of nephrotic syndrome
- Thromboembolism
- infections
- AKI if diuretics too aggressive
- Hyperlipidemia
How does glomerular proteinuria occur
When there is increase permeability of the glomerular capillary wall
What proteins are seen for tubular proteinuria
LMW proteins eg beta 2 microglobulin, alpha 1 microglobulin, retinol binding protein
What happens in overflow proteinuria
There is an increased production of smaller proteins eg in myeloma leading to filtration more than reabsorptive capacity
What are some causes of non-nephrotic range proteinuria
- mild glomerular disease
- tubulointestinal disease
- acute tubular necrosis
- hypertension
- collagen vascular disease
- multiple myeloma
- bacterial endocarditis
What are the causes of AKI in nephrotic syndrome
- over diuresis
- interstitial edema from severe hypoalbuminemia
- ischemic tubular injury
- interstitial nephritis due to diuretics
- renal vein thrombosis
what are the causes of hyperlipidemia
- low oncotic pressure that stimulate lipoprotein production by hepatocytes
- hypercholesterolemia due to decreased clearance of lipoproteins
- hypertriglyceridemia due to defect in triglyceride metabolism
What are some indication for renal biopsy
1) Persistent proteinuria >0.5g/day with active urine sediment
2) Rapid deterioration in renal function
3) Proteinuria >1g/day
How do you manage infections in patients
- prophylactic bactrim if on immunosuppresant
- Anti-pneumococcal and influenza vaccinations
