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6 Cards in this Set
- Front
- Back
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Nephrotic Syndrome - definition |
1. Massive proteinuria 2. Hypoalbuminaemia 3. Oedema (dec colloid osmotic pressure) 4. Hyperlipidaemia ! Not a disease - constellation of signs/symptoms. |
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Nephrotic syndrome - cause |
Depends on age. 1. Children - minimal change disease (most common) 2. Younger adults - focal segmental glomerulosclerosis; minimal change nephropathy 3. Older adults - Membranous nephropathy, diabetic nephropathy (with longstanding DM2) |
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Pathophysiology |
- Glomerular proteinuria develops when glom filtration barrier is disrupted by disease. - Hypoalbuminaemia - urinary loss - Hyperlipidaemia - liver increases production of albumin and LDL, VLDL and lipoprotein a., in response to hypoalb. - Hypercoag - loss of inhibitors to coag in urine and inc synthesis of pro-coags by liver. - Oedema - dec oncotic pressure (hypoalb) and primary defect in Na+ excretion. - Infection - loss of Igs and complement in urine |
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DDx |
1. Minimal change disease (esp children) 2. Focal segmental glomerulosclerosis 3. Membranous nephropathy 4. Diabetic nephropathy 5. Multiple myeloma-associated AL amyloidosis 6. IgA nephropathy 7. Other less common |
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Oedema differential |
- CCF - Hepatic disease - pt with n.s. often can lie flat, so get facial oedema cf. CCF and liver disease which can't. - urinalysis!! proteinuria not present in CCF and hepatic disease. |
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Nephrotic Syndrome - complications |
1. Hyperlipidaemia = accelerated atherosclerosis and CVS disease 2. Thrombosis and thromboemoblism (loss of anticoag proteins through leaky glomeruli) 3. Loss of Ig leads to increased infections. |
