Nephrotic Syndrome - Kidney Disease

Nephrotic Syndrome

·        ~ Non-proliferative glomerulonephritis

·        Presentation:

o   Marked proteinuria (may make urine frothy) > 3 g/day 

·        Hypoalbuminaemia ® oedema: generalised, insidious onset, may be peri-orbital in the morning, legs in the afternoon. If gross then ascites and pleural effusion

o  Hypercholesterolaemia 

o  Renal function is preserved.  But may retain Na and H20. May ­ plasma volume

o  If polyuria then Þ tubular and interstitial damage as well 

·        Pathogenesis: common end point of a variety of disease processes that alter the permeability of the basement membrane

·        Possible causes (first 3 reasonably common in adults, Membranous is perhaps the most common):

o  Minimal change GN

o  Membranous GN

o  Focal Segmental GN

o  Maybe IgA and mesangiocapillary

o  (Also diabetes, amyloidosis (eg multiple myeloma), drugs)

·        Management: 

o  Minimal change: very responsive to steroids. The rest need something stronger (eg cyclophosamide) and commonly ® renal failure over time

o  Fluid restrict

o  Monitor and treat BP

o  Salt restricted, high protein diet 

o  Oral diuretics + K (beware hypovolaemia ® pre-renal failure) 

·        Complications: loose Antithrombin 3 protein as well as albumin ® renal vein (and other) thrombosis. ?Prophylactic anticoagulation