Flashcards in Proteinuria Deck (15):
How is proteinuria defined microscopically?
• Early morning collection
○ P:Cr ratio > 20mg/mmol
○ Albumin:Cr ratio > 3.5mg/mmol
How does proteinuria affect renal prognosis?
• Quantity of protein equates to renal prognosis, except for in the case of minimal-change disease.
Compare features of nephrotic vs nephritic syndrome.
1. Proteinuria (>3.5g/24h)
2. Hypoalbuminaemia (30mg/L)
3. Oedema - everywhere, pitting, non-dependent oedema
5. (Only a small increase in BP)
6. 🐝 Fatty casts in urine
7. Filtration normal
1. High BP**
2. Macroscopic haematuria
4. Raised serum Cr
5. 🐝red cell casts
- Filtration abnormal
- Mild proteinuria and mild oedema only
What is the most common cause of nephrotic syndrome in children? What is the buzz word for it?
Minimal change GN - swelling/puffy face: responsive to steroids
Outline causes of nephrotic syndrome in children
• Idiopathic nephrotic syndrome
○ Minimal change disease (85%)
○ Focal segmental glomerulosclerosis (10-15%)
• Non-idiopathic (rare):
○ Secondary: SLE, HSP, MPGN
○ Membranous nephropathy
○ Congenital nephrotic syndrome
What is the classic presentation for minimal change GN?
2-10 years, atopic, triggered by infection
Outline where oedema can occur/what it can lead to, and thus outline mild-mod-severe oedema.
• Or associated weight gain/poor urine output/dizziness
• Mild (subtle peri-orbital region, scrotum or labia)
• Moderate with peripheral pitting oedema of the limbs and sacrum.
• Severe with gross limb oedema, ascites and pleural effusions.
What are the possible complications of nephrotic syndrome?
• Infection (especially susceptible to encapsulated bacteria)
- Cellulitis from gross oedema with skin compromise
- Spontaneous bacterial peritonitis – abdominal pain, fever, nausea/vomiting, rebound tenderness
• Thrombosis: DVT, PE, renal vein thrombosis, cerebral vein thrombosis
What are some DDx for nephrotic syndrome?
- Cardiac failure
- Liver failure
- Protein losing enteropathy causing oedema
What are some Rx used in managing nephrotic syndrome?
1. Steroids - underlying cause (course 6 weeks with weaning
2. Symptoms: albumin and frusemide IV
• Albumin causes brief increased plasma oncotic pressure
• Then quickly give frusemide to help the kidneys flush it out
3. Prevention of complications:
• Penicillin (prevents infection)
• Aspirin (clotting)
• Ranitidine (prevents gastritis)
• (Na + fluid moderation)
What percentage of INS will respond to steroids? What is important to remember about steroid-sensitive nephritic syndrome?
- 90% INS respond to steroids
- SSNS 80% chance of relapse
What is important to educate a family about re: nephrotic syndrome management?
• Amount of water can drink and salt restriction
• How to do urine dipstick - daily (rec even for 1-2 years post-remission)
• Steroids during infection to prevent relapse
• Vaccinations usually wait until after steroid, except pneumococcal and flu
What are some common causes of nephritic syndrome in children?
e.g. SLE, IgA, post-streptococcal glomerulonephritis
- how long following URTI
- Ix results
• 2-4 weeks following strep skin/throat infection
• Positive streptococcal serology
• Low C3, possibly normal C4
• Rarely need biopsy
• Rx: frusemide