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Risk Factors, MINIMAL CHANGE NEPHROPATHY, Anorexia, TBL 4.3 MECHANISTIC…
Risk Factors
Structural changes
No immune deposits - No IF changes
Electron microscopy
Immunofluorescence
Effacement of podocyte foot processes
Albumin permeable through filtration apparatus
Loss of albumin in urine
Proteinuria
Frothy urine
Urine biochemistry - 16.1g/day (nephrotic range is >3.5g/day)
Hypoalbuminemia
Decreased vessel oncotic pressure
Fluid moves into interstitium
Orthostatic hypotension
Liver attempts to counteract by producing more albumin
Liver also produces more lipids
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Pitting oedema
Leg elevation
Pulmonary oedema
Shortness of breath
Pleural effusion
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Decreased effective blood volume
Increased sympathetic activity
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Decreased perfusion of kidney
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Elevated haematocrit - 0.57 (due to drop in plasma volume)
Lethargy
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Nausea
Ascites
Renal ultrasound
Treat symptoms associated with oedema with diuretic (e.g. frusemide)
Periorbital/facial swelling
Low salt diet
Serum albumin 11g/L
Hypocalcemia (calcium lost in urine)
Disruption of glomerularfiltration apparatus
Loss of vitamin D
Less calcium absorption
Hypocalcaemia
Malnourishment enhances infection risk
Serum calcium 2.0 mmoL/L
Loss of immunoglobulins
More prone to infections
Loss of anti-coagulants
More prone to clots
Presence of casts
Moderate hyaline casts, occasional fine and coarse granular casts
Sterile pyuria
Elevated WCC (8x10^6)
Slight haematuria
Elevated RBC count (4x10^6)
No tubulo-interstitial damage
Slight mesangial matrix expansion
Light microscopy
Viral upper respiratory tract infection 2 weeks previously
T cell lymphokine
Decreased negative charge barrier
Treat with minimum 3 months of corticosteroids (immunosuppression)
Side effect of mood changes
Bipolar medication (sodium valproate)
May cause renal tubular damage
Decrease in GFR
Increased serum creatinine and urea
Smoker (2 packs a day)
Alcohol consumption
Bipolar disorder
MINIMAL CHANGE NEPHROPATHY
Anorexia
TBL 4.3 MECHANISTIC DIAGRAM
Gerry Guo, Kara Harris, Mohammed Hassan, Christy Hou & Daniel Kasunic