Loss of protein in urine
GBM has negative charge to repel proteins
(Left) Loss of negative charge
Causes/Factors
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Minimal change disease - most common cause in children. Usually idiopathic and treated with steroids
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Membranous nephropathy - most common cause in adults
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Focal Segmental Glomerulosclerosis - most common cause in adults
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Amyloid
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HIV, HEP B&C, malaria
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NSAIDs
Tip
Minimal change disease often comes up in exams. If there’s a 2-5 year old child with oedema proteinuria and low albumin the diagnosis is likely nephrotic syndrome.
Symptoms
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Proteinuria
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Hypoalbuminaemia
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Oedema - ankles, feet, eyes (in severe)
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Hypercholesterolaemia
Signs
- Peripheral oedema
- Frothy urine
- Weight gain
- Fatigue
- Loss of appetite
Diagnostic Tests
- Urinalysis
- Blood tests
- Biopsy
Management
Specific
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Steroids
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Cyclophosphamide, tacrolimus
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Loop diuretics Furosemide
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BP control - ACEi
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Hypercholesterolaemia - statins
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Thrombo-prophylaxis - herparin
Complications/red Flags
- Thrombosis - due to loss of blood blotting proteins
- High blood cholesterol and elevated blood triglycerides - live makes more albumin along with cholesterol and triglycerides
- Poor nutrition - loss of blood protein
- High BP
- Acute Kidney Injury
- Chronic Kidney Disease
- Infections