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Medicine Notes Renal System Notes

Nephrotic Syndrome Notes

Updated Nephrotic Syndrome Notes

Renal System Notes

Renal System

Approximately 31 pages

These notes helped me achieve a mark of 78% in my renal system exam, which is the equivalent of a 1st. The notes are based on a series of lectures on the subject. This is a very good, thorough and in depth review of the nervous system. They are very clearly laid out and easy to follow. They cut out unnecessary information on the topic, making the notes very concise, and fast to get through. Anyone studying medicine, or any other subject requiring knowledge of the renal system (e.g. physiology or ...

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The following is a more accessible plain text extract of the PDF sample above, taken from our Renal System Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Lecture 13

Nephrotic syndrome

  • General

    • Course of disease

      • Heavy proteinuria

      • Hypoalbuminaemia (Hyperlipidaemia)

      • Oedema

        • Leak fluid into ‘third space’

    • Symptoms

      • Oedema

      • Hypoalbuminaemia

      • Proteinuria

      • Hyperlipidaemia

    • Different from nephritic syndrome, in which you are more likely to have

      • High BP

      • Acute renal impairment

      • Haematuria

      • Less oedema

  • Pathophysiology of nephrotic syndrome

    • Normal

      • Three layers of glomerulus from blood layer to inner space

        • Endothelium (fenestrated)

        • Glomerular BM

        • Podocytes

      • 180 litres/day of water and small molecules pass through glomerulus

      • Almost no protein

    • Nephrotic syndrome

      • Simplification of podocyte architecture

      • Podocyte effacement (shortening or thinning of tissue)

      • Protein (such as ALBUMIN) is able to pass through glomerular barrier

  • Classification of nephrotic syndrome

    • CONGENITAL

      • General

        • Rare, inherited conditions

        • Proteinuria in utero or in early infancy

        • Breakdown in glomerular filtration barrier- at podocyte level

        • Usually rapid onset of ESRF

        • No response to steroids or Cytotoxics

        • Transplantation

      • Genes

        • NPHS1- nephrin

        • NPHS2- podocin

    • ACQUIRED (e.g. Primary glomerulopathy)

      • Minimal change nephrotic syndrome

        • Signs and symptoms

          • Don’t see any difference in microscopy

          • Proteinuria, oedema, Hypoalbuminaemia

          • Risk of IV depletion, infection etc.

          • Episodes of relapse and remission

          • Often exquisite response to steroids

          • No glomerular infiltrate/signs of immune mediated damage

        • Treatment

          • Corticosteroid (prednisolone- 90% respond initially)

            • 30%= no relapse; 30%= infrequent relapse; 40%= frequent relapse

          • 2nd line therapy

            • Levamisole (anti-helminthic)

            • Cytotoxics

              • Cyclosphosphamide/Chlorambucil

                • Marrow suppression, infertility

              • Cyclosporin A

        • Clinical complications

          • THROMBOSIS

            • Haemoconcentration

            • Increased fibrinogen, factor VII, X, VIII

            • Decreased anti-thrombin III & plasminogen

          • INFECTIONS

            • Immunological losses

              • Pneumococcal infections; Peritonitis

            • Drugs

            • Tissue oedema

      • ...

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