questions 0

Secondary Nephrotic Syndrome

Author:
Topic updated on 12/21/15 3:15pm

Introduction
  • Secondary nephrotic syndrome is a multisystem disease 
  • Primary nephrotic syndrome refers to disease limited to kidney
Presentation
  • Hypoalbuminemia (serum albumin of <3.0 g/dl)
  • Proteinuria > 3.5 g/day
  • Generalized edema (anasarca)
    • caused by loss of albumin / decreased oncotic pressure
  • Hyperlipidemia with lipiduria
    • low albumin stimulates liver to produce cholesterol
 
Evaluation
  • Diagnosis made by renal biopsy
 
Nephrotic Syndrome
Nephritic Syndrome
Chronic Disease
Proteinuria
+ + +
+ / -
+ / -
Hematuria
+ / _
+ + +
+ / -
Cells
+ / _
+ RBCs / + WBCs
+ / -
Casts
Fatty Casts
RBC and granular casts
Waxy/pigmented/granular casts
Lipids
Free fat droplets
Oval fat bodies
   


Diabetic Glmerulonephropathies
  • Most common cause of end stage renal disease in USA
  • Early manifestation is microalbuminuria
  • Biopsy shows pathognomnic Kimmelstiel-Wilson nodules
  • Treatment
    • can slow progression with
      • ace inhibitors
      • strict glycemic and hypertension control
    • transplant is only treatment after disease has progressed
HIV Glmerulonephropathies
  • Usually seen in HIV acquired through IV drug use
  • Presents with focal segmental glomerulonephritis
  • Treat HIV
Lupus Glomerulonephritis
  • Type I
    • no renal involvement
  • Type II
    • mesangial disease with focal segmental glomerular pattern
  • Type III
    • focal proliferative disease
    • treat with aggressive prednisone +/- cyclophosphamide
  • Type IV
    • most severe form
    • diffuse proliferative disease
    • presents as combination of nephritic / nephrotic disease
    • classic wire loop abnormality
    • treat with prednisone, cyclophosphamide, transplant
  • Type V
    • membranous disease
    • indistinguishable from other primary membraneous glomerulonephropathies
    • Treatment: consider prednisone
Generalized treatment
  • Protein restriction
  • Salt restriction
  • Diuretic therapy for edema
  • HMG-CoA reductase inhibitor for hyperlipidemia

 



  RATE CONTENT
5.0
AVERAGE 5.0 of 1 RATINGS

Qbank (0 Questions)



Evidence & References Show References




Topic Comments

Subscribe status: