Renal System >
Nephrotic Syndrome
A syndrome consisting of symptoms related to damage to the kidney (Basement Membrane & Podocytes)
Risk Factors
- Modifiable:
- Medications that affect Kidney function (such as NSAIDs)
- Diabetes (diet control)
- Non-Modifiable:
- Diseases affecting the kidneys (such as Diabetes and Amyloidosis)
- Infections (such as HIV, Hep B/C, Malaria)
Aetiology
- Primary:
- Non-proliferative types of Glomerulonephritis (such as membranous glomerulonephritis)
- Minimal change disease (common in children)
- Focal segment Glomerulonephritis (common in adults)
- Secondary
- Diabetic Nephropathy
- Amyloidosis
- Light chain deposits in myeloma
Pathophysiology
- Structural damage to basement membrane/podocytes
- In Membranous Glomerulonephritis, immune complexes form on the basement membrane and disrupt the podocyte foot processes
Clinical Presentation
- Insidious onset with triad classical presentation:
- Massive proteinuria (frothy urine)
- Hypoalbuminemia (<30g/L)
- Oedema
- May have hyperlipidaemia and hypercoaguability (may lead to DVT/PE formation)
Investigations
- Bloods:
- Urea and Electrolytes
- Creatinine – Elevated
- Increased clotting factors
- Hyperlipidaemia
- Hypalbuminaemia
- Imaging: n/a
- Special:
- Urinalysis – Massive proteinuria
- Albumin: creatinine ratio (ACR) – Massively raised
Management
- Conservative: n/a
- Medical:
- High dose oral steroids – 90% of cases respond
- Symptomatic Treatment
- Loop diuretics (for oedema)
- Prophylactic LMW-Heparin (for hypercoagulability)
- Statins and Fibrates (for severe hyperlipidaemia)
- Increase protein intake (for hypalbuminaemia)
- Surgical: n/a
Complications
- Increased risk of infection (urinary immunoglobulin loss)
- Increased risk of thromboembolism (loss of anti-thrombin III in urine)
- Hyperlipidaemia
- Hypocalcaemia (Vit D and binding protein lost in urine