Nephrotic Syndrome

  • Created by: MazzaW
  • Created on: 22-11-19 10:43

Nephrotic Syndrome

Proteinuria (>3.5g in 24hrs, PCR>300), Hypoalbuminaemia (<30g/L), Oedema (albumin loss -> reduced oncotic pressure -> oedema, effusions, ascites)

Can cause:

  • hypercholesterolaemia (increased synthesis of proteins, including lipoproteins)
  • hypercoagulability/thrombosis (loss on antithrombin III)
  • infection (loss of Ig)
  • malnutrition/growth failure (loss of protein)
  • renal failure
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Minimal change disease

Commonest cause of nephrotic syndrome in children

Causes foamy urine and oedema

Can be secondary to NSAIDs, Hodgkin's lymphoma, atopy

Steroid responsive, no long-term damage

Light microscopy: minimal change

Electron microscopy: podocyte effacement

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FSGS (focal segmental glomerulosclerosis)

Commonest PRIMARY cause of nephrotic syndrome in adults

Scarring of part of the glomerulus in some glomeruli

Causes nephrotic syndrome and renal impariment

Associated with: HIV, heroin use

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Membranous GN

Immune complex formation in sub-endothelium damaging podocytes- GBM thickening in spike and dome pattern

Mostly idiopathic (85%) but can be secondary: cancers, hepatitis, SLE, gold/penicillamine

Can cause CKD

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Diabetic nephropathy

Commonest cause opf adult nephrotic syndrome and end-stage renal failure.

Causes albuminuria, HTN, renal insufficiency- can progress to nephrotic syndrome

Kidneys initially swell then shrink

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Membranoproliferative GN (MPGN)

Immune complexes from chronic infection (e.g. Hep C) deposit in sub-endothelium

Causes GBM thickening + mesangial cell proliferation

Associated with hep C, SLE, cryoglobulinaemia

Borderline nephritic/nephrotic syndrome

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