Nephrotic Syndrome

 A. REVIEW

B. DISCUSSION 

A. REVIEW

CLINICAL FEATURES

Proteinuria ( >3.5g in 24 hours)

Hypoproteinemia 

Edema

Hyperlipidemia

Hematuria (minimal)

Hypertension

Nephrotic syndrome occurs due to damaged glomeruli. Damaged glomeruli allow blood proteins (including albumin) to leak out in urine

Kidney diseases causing nephrotic syndrome

Focal segmental glomerulosclerosis (FSGS)

Minimal change disease (MCD)

Membranous nephropathy

Diabetic nephropathy

Amyloidosis

INVESTIGATIONS

Urine analysis - Dipstick test

Detects albumin in urine

24 hour urine test

Test for detection of albumin in 24 hour urine sample

Blood test

A low level of albumin in blood can indicate nephrotic syndrome

Increase blood cholesterol and increased blood triglyceride levels also happen in nephrotic syndrome

Renal biopsy

TREATMENT

Nephrotic syndrome is not curable

Treatment is focused on to relieve nephrotic syndrome symptoms and to prevent further damage to kidneys

Medications

Anti hypertensives 

ACE inhibitors

Angiotensin receptor blockers

Diuretics

Beta blockers

Calcium channel blockers

Antihypertensives reduce the blood pressure inside glomeruli thus decreasing albuminuria

Statins 

Statins reduce  cholesterol levels

Anticoagulants

To prevent blood clots

B. DISCUSSION

1. What are the other causes of hypoproteinemia other than nephrotic syndrome?

Malnutrition - Kwashiorkor syndrome

Occurs due to decreased protein intake

Chronic liver disease - Occurs due to decreased protein synthesis

Malabsorption syndrome - Occurs due to decreased absorption of protein

Menetrier disease - Protein losing enteropathy

2. Why does edema occur in Nephrotic syndrome?

Hypoproteinemia happens in nephrotic syndrome because of loss of a large amount of protein in blood. Because of decreased protein in blood the plasma oncotic pressure decreases. As a result fluid leaves the capillary because the hydrostatic pressure exceeds the plasma oncotic pressure. This fluid leaving the capillary accumulates in the interstitial space leading to edema.

3. Why does thrombosis occur in nephrotic syndrome?

Because of loss of the protein antithrombin 3

4. Is there increased risk of infections in nephrotic syndrome?

Yes there is. Because of loss of antibodies.