Nephritic / Nephrotic Syndrome

Posted by e-Medical PPT Monday, August 22, 2011
Causes of generalised oedema
Nephrotic syndrome
Protein energy malnutrition
Protein losing enteropathy
Cardiac failure
Liver disease
Generalised allergic reaction

Comprehensive history (renal focus)
Congenital deafness and renal failure in 1st degree relatives – Alport syndrome (plus many others –BOR, ARRTA, Bartter, etc.)
Stroke and renal failure – ADPKD
Consanguinity – ARPKD
Renal calculi, dialysis, transplantation
Birth history, lines, birth weight, placental size (placentomegaly ->25% of BW, congenital nephrotic syndrome)
Maternal drug (NSAID, ACEs, cocaine) and alcohol use

Clinical Assessment
Age appropriate
Neonatal and infants – most commonly nephrotic syndromes
Children – mixed nephrotic or nephritic syndromes 
Adolescents – more likely nephritic syndromes

Predominantly nephrotic
Oedema
Proteinuria  2 – 3 + or more
Less hypertension     
                    
Predominantly nephritic
Fluid overload
Haematuria and less proteinuria
More hypertension

Classification of Congenital and Early-Onset Nephrotic Syndrome
Congenital nephrosis of the Finnish type
Diffuse mesangial sclerosis, FSGS, membranous glomerulosclerosis, minimal change
Syndromes
 - Denys-Drash, Galloway – Mowat syndrome, Lowe's, Frasier and Pierson

Aetiological Classification (early or late onset)
Infections
          - Congenital syphilis
          - Toxoplasmosis, rubella, CMV, hepatitis B & C, HIV
          - Malaria
SLE

Predominantly Nephritic
Commonest:
Post-infectious GN – APSGN, Hepatitis B and C, HIV, Infective endocarditis
IgA nephropathy
Henoch-Schonlein Purpura nephritis
Hereditary nephropathies – Alport syndrome
Vasculitides – ANCA positive/ pauci-immune GN, SLE
Membranoproliferative (MPGN)

Criteria for Admission of APSGN
Hyperkalaemia
Hypertension
Seizures
Oliguria
Congestive heart failure....

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