nephrotic syndrome
Being a syndrome, not a well defined disease all on its own
| proteinuria, hypoalbuminaemia and peripheral oedema | |
|---|---|
| Etiology | Idiopathic: FSGS, minimal change disease (most common in children) → can relapse - membranous nephropathy (see below), diabetic nephropathy Autoimmune: Amyloidosis, SLE |
| Epidemiology | |
| Clinical presentation | - primary cause (see below) |
| Pathogenesis | podocytes disrupted by disease process = glomerular barrier damaged → inappropriate urinary excretion of albumin and other proteins - loss of Protein C and S = hypercoagulable state - loss of immunoglobulins = risk of infection |
| Diagnostic investigations | Bloods: ↑ lipidaemia; secondary causes (see below) Urine: protein-creatinine ratio >300; fatty casts Renal biopsy |
| Management | VTE prophylaxis |
membranous nephropathy
may be primary or secondary
secondary:
- malignancy
- infection (Hepatitis B 1, HIV 1, Malaria clinical presentation)
- diagnostic investigations: RPR syphilis, Hep B serology, anti-dsDNA, ANA, C3, C4... what else can you think of?
- drugs (penicillame, NSAIDs, GOLD?????)
- some Chinese herbs! (which ones, BMJ? WHICH ONES???)