Nephrotic syndrome - Medicine - RDT

Topic: Nephrotic Syndrome
Faculty: General Medicine
Course: BSc RDT - 2nd year

- Definition, Causes, Pathogenesis, Complications, Clinical Features, Diagnosis and Treatment of Nephrotic Syndrome

- Minimal Change Disease

1. NEPHROTIC SYNDROME Dr. Salman Ahmad Ansari(MBBS) Kanachur Institute of Medical Sciences

2. Contents Definition of Nephrotic Syndrome Causes Pathogenesis Complications Clinical Features Diagnosis Treatment Minimal Change Disease

3. Nephrotic syndrome Nephrotic syndrome is characterized by: Massive/heavy proteinuria (>3.5 g of protein/24 hours) Hypoalbuminemia Edema Hyperlipidemia Lipiduria. Occurs due to leakage of proteins from damaged basement membrane

4. Etiology Causes can be primary (glomerular) or secondary (systemic) Membranous glomerulonephritis(in adults) Minimal change disease(in children) Focal segmental glomerulosclerosis(adults) Diabetes mellitus Amyloidosis Systemic Lupus Erythematosus(SLE)

5. Etiology Most common in adults: membranous glomerulonephritis(MGN) Most common in children : minimal change disease(MCD) Most common systemic causes: diabetes , amyloidosis , and SLE . Mnemonic : kids love McDonald’s(McD)

6. Pathogenesis

7. Basement membrane Podocytes

8. Damage to podocytes(due to toxins/antibodies/infections) ↓ Glomerular Basement Membrane(GBM) becomes more permeable ↓ Leakage of substances like protein(like albumin) from blood into urine ↓ Pathogenesis

9. Massive proteinuria occurs(>3.5g/day) ↓ Leads to decreased levels of albumin in blood(“ hypoalbuminemia ”) ↓ Leads to decreased oncotic pressure and plasma volume, which results in aldosterone secretion and promotes sodium and water retention ↓ Edema Pathogenesis(...continuation)

10. Hypoalbuminemia also stimulates synthesis of lipoproteins by liver Increased levels of lipid in blood( hyperlipidemia ) More lipid will be excreted in urine( lipiduria )

11. Complications of nephrotic syndrome Increased risk of Atherosclerosis due to hyperlipidemia Infections due to loss of immunoglobulins 3. Thrombosis and embolism due to loss of natural anticoagulants in blood(antithrombin III)

12. Clinical features Children and adults affected Generalised Edema Appears in face around the eyes first and then the body Frothy urine Tiredness

13. Diagnosis Urine tests : Dipstick shows 3+ protein 24 hour urine sample shows >3g protein Blood tests : Serum albumin level: low Serum cholesterol and triglycerides: increased Renal biopsy may be needed in some cases Normal S. albumin 3.5-4.5 g/dl

14. Treatment of nephrotic syndrome 3 steps Measures to reduce proteinuria Measures to control complications of nephrotic syndrome Treatment of underlying cause

15. Treatment of nephrotic syndrome Specific treatment depends upon cause and age group Corticosteroids are mainstay of treatment Initial treatment with high dose prednisolone for 4-6 weeks followed by lower dose for 4-6 weeks Treat edema : Diuretic medication e.g: thiazide diuretic( bendroflumethiazide ) Low salt diet to prevent further edema

16. Diet should contain enough calories and protein(1 g/kg/day) Restrict lipids in diet Monitor weight and BP of patient If proteinuria continues, start ACE inhibitors or ARB(angiotensin receptor blocker)

17. Minimal Change Disease

18. Minimal change disease(MCD) Most common cause of nephrotic syndrome in children (80%) Renal biopsy shows normal-appearing glomeruli on light microscopy Electron microscopy: shows Effacement(thinning) of foot processes of podocytes Clinical features: Edema: periorbital and generalised edema Frothy urine

19. Investigations: Urine analysis(dipstick) for proteinuria Renal biopsy Serum albumin levels: low Treatment: Daily prednisolone for 4 weeks followed by alternate day prednisolone for 4 weeks Low salt diet, restrict fluids Diuretics to treat edema Relapse treated with steroid regimen if responsive

20. Summary - Nephrotic syndrome Definition: 5 things Causes In adults 👨? In children 👶? Commonest systemic causes? Pathogenesis Injury to _______? Loss of _____ in urine Low level of ______ in blood Hypoalbuminemia leads to ____ in body and hyper_____

21. Clinical features Edema Frothy urine Diagnosis: Urine dipsticks shows __ protein Serum albumin: ? Treatment: ? ______ 💉 Diet should be low in ____

22. References: Archith Boloor, Ramadas Nayak - Prep Manual for Undergraduates - Medicine K. George Mathews - Prep Manual for Undergraduates StatPearls - Nephrotic syndrome Questions: [email protected] For PPT, scan: For notes, click here or scan: