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Flashcards in Proteinuria Deck (15):
1

How is proteinuria defined microscopically?

• Early morning collection 
○ P:Cr ratio > 20mg/mmol 
○ Albumin:Cr ratio > 3.5mg/mmol 

2

How does proteinuria affect renal prognosis?

• Quantity of protein equates to renal prognosis, except for in the case of minimal-change disease. 

3

Compare features of nephrotic vs nephritic syndrome.

Nephrotic:
1. Proteinuria (>3.5g/24h)
2. Hypoalbuminaemia (30mg/L)
3. Oedema - everywhere, pitting, non-dependent oedema
4. Hyperlipidaemia
5. (Only a small increase in BP)
6. 🐝 Fatty casts in urine
7. Filtration normal

Nephritic:

1. High BP**
2. Macroscopic haematuria
3. Oliguria
4. Raised serum Cr
5. 🐝red cell casts
- Filtration abnormal  
- Mild proteinuria and mild oedema only

4

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

5

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

6

What is the classic presentation for minimal change GN?

2-10 years, atopic, triggered by infection 

7

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.

8

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

• Dehydration 
• Effusions  

9

What are some DDx for nephrotic syndrome?

- Cardiac failure
- Liver failure
- Protein losing enteropathy causing oedema

10

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)

11

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

12

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

13

What are some common causes of nephritic syndrome in children?

e.g. SLE, IgA, post-streptococcal glomerulonephritis 

14

Post-strep GN:
- how long following URTI
- Ix results
- Rx

• 2-4 weeks following strep skin/throat infection 
• Positive streptococcal serology 
• Low C3, possibly normal C4 
• Rarely need biopsy
• Rx: frusemide

15

List some investigation you might order to investigate nephritic syndrome.

Haematology
• FBE, film
• UEC (biochem)
• ESR
• PTT
• Prothrombin / INR
• Fibrinogen

Bacteriology
• MSU-MCS
• Pr:Cr
• Phase contrast micro for red cell casts

Virology (selected cases only)
• Hepatitis B Surface Antigen
• Hepatitis C and CMV antibodies
• HIV antibodies

Immunology
• Serum Complement ( C3 and C4) Immunoglobulins
• Anti- Double Stranded DNA 
• ANF
• ASO Titre
• Anti- streptococcal DNase B titre
• Blood culture/throat swab

Procedure/imaging
• US
• Biopsy