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

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