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