Topic: Nephrotic syndrome Faculty: Pathology Course: Renal Dialysis Technology(RDT) 2nd year Nephrotic syndrome: definition, causes, pathogenesis, clinical features, diagnosis, treatment and case study

1. Practicals:
NEPHROTIC SYNDROME
Dr. Salman Ahmad Ansari
MBBS
18/02/23

2. Nephrotic syndrome
● Definition
● Causes
● Pathogenesis
● Features
● Diagnosis
● Treatment
● Case study

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
glomerulopathy(in adults)
● Minimal change disease(in
children)
● Focal segmental
glomerulosclerosis(adults)
● Diabetes
mellitus
● Amyloidosis
● Systemic Lupus
Erythematosus(
SLE)

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

7. Pathogenesis

9. Basement membrane
Podocytes

11. Damage to podocytes(due to toxins/antibodies/infections)
● Glomerular Basement Membrane(GBM) becomes more permeable
● Leakage of substances like protein(albumin mainly) from blood into
urine
● 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
● Leads to edema

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

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

16. 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

17. Treatment of nephrotic syndrome
● Specific treatment depends upon cause and age group
● Corticosteroids are mainstay of treatment
● Diuretics may be needed
● Diet should contain enough calories and protein(1 g/kg/day)
● Low salt diet to prevent further edema
● Monitor weight and BP of patient

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

19. Summary
● 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_____

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

21. Case study
5 year old girl was brought to hospital with generalised edema since 15 days.
Her tests were as follows:
1. Physical examination:
Quantity 1400ml/day
Colour Yellow
Appearance Turbid
Specific gravity 1.030
2. Chemical examination:
pH 7.2
Protein +++
Blood Absent
Sugar Absent
Ketone bodies Absent
3. Microscopic examination:
Pus cells 2-3/hpf
Epithelial cells 3-4/hpf
RBCs Absent
Cast, crystals Absent

22. Questions:
Q1. What is the diagnosis?
Q2. Define nephrotic syndrome and enumerate the causes.
Answers:
A1. Nephrotic syndrome
A2. It is a syndrome characterised by massive proteinuria(3.5g/day), hypoalbuminemia, edema,
hyperlipidemia and lipiduria.
Causes: Primary Systemic
Minimal change disease(children) Diabetes
Membranous glomerulonephritis(adults) Amyloidosis
Focal segmental glomerulosclerosis(adults) Systemic Lupus Erythematosus

23. References:
● Ramadas Nayak - Textbook of Pathology for
Undergraduates
● StatPearls - Nephrotic syndrome
Questions:
salman.s.ansari92@gmail.com
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