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Nephrotic Syndrome (Diagnosis (BP is usually normal or mildly increased,…
Nephrotic Syndrome
Diagnosis
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Serum creatinine, eGFR, lipids and glucose
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ANA, double-stranded DNA antibody, C3 & C4 indicated SLE
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HepB surface antigen, HepC antibody or HIV
Clinical Presentation
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Pitting oedema of ankles, genital, abdominal wall and sometimes face (periorbital)
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Key Facts
Severe hyperlipidaemia is often present - liver goes into overdrive due to albumin loss and other protein loss which increases risk of blood clots and produces raised cholesterol
Don't develop kidney failure but are leaking HUGE amounts of protein but kidney function remains the same
Triad of:
- Proteinuria >3.5g/24hrs
- Hypoalbuminaemia
- Oedema
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Treatment
Reduce proteinuria - ACEi, ARB, eat normal rather than high protein diet
Reduce risk of complications - prophylactic anticoagulation with warfarin, reduce cholesterol with statins, treat infections promptly and vaccinate
Reduce oedema - loop diuretics, thiazide diuretics, fluid and salt restriction while on diuretics
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Epidemiology
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Minimal change disease accounts for 10-25% of nephrotic syndrome in adults and is the commonest cause of nephrotic syndrome in children
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Pathophysiology
Podocytes wrap around the glomerular capillaries and maintain the filtration barrier - preventing large molecular weight proteins from entering the urine
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Complications
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Susceptibility to infection - due to low serum IgG, decreased complement activity and reduced T cell function
Aetiology
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Secondary causes
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Drugs e.g. gold, penicillamine, NSAIDs and ACEi
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Differential Diagnosis
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Cirrhosis
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But there are signs of chronic liver failure e.g. jaundice, fever and loss of body hair
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