Nephrotic Syndrome AAFP PDF

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Questions and Answers

Which of the following is NOT a potential presenting feature of nephrotic syndrome?

Vomiting (correct)

Exertional dyspnea

Pleural effusion

Ascites

What is a significant challenge when confirming proteinuria in patients suspected of having nephrotic syndrome?

Difficulty in distinguishing protein types

Cumbersome 24-hour urine collection (correct)

Inconsistent albumin levels

False positives in urine dipstick tests

In patients with idiopathic nephrotic syndrome, when is a biopsy more likely to be useful?

If they have a known histologic disease type

When there are systemic symptoms of lupus (correct)

In cases of renal failure

When they present with ascites only

What symptom might patients with nephrotic syndrome report that indicates fluid retention?

Foamy urine Signup and view all the answers

What is a common complication associated with nephrotic syndrome?

Hyperlipidemia Signup and view all the answers

What autoimmune condition is associated with secondary nephrotic syndrome?

Systemic lupus erythematosus Signup and view all the answers

Which of the following infections can cause secondary nephrotic syndrome?

Herpes zoster Signup and view all the answers

Which type of cancer is specifically noted as a potential cause of secondary nephrotic syndrome?

Carcinoma Signup and view all the answers

Which drug is linked to secondary nephrotic syndrome due to its usage?

Lithium Signup and view all the answers

What genetic syndrome is known to be a cause of secondary nephrotic syndrome?

Alport syndrome Signup and view all the answers

Which of the following viral infections can lead to secondary nephrotic syndrome?

Hepatitis B and C Signup and view all the answers

Which metabolic condition is a known contributor to secondary nephrotic syndrome?

Diabetes mellitus Signup and view all the answers

Which infectious disease, characterized by protozoa, can result in secondary nephrotic syndrome?

Filariasis Signup and view all the answers

What is the minimum spot urine protein-to-creatinine ratio that indicates heavy proteinuria?

<blockquote> 3.0 mg protein/mg creatinine </blockquote> Signup and view all the answers

What is one reason patients with nephrotic syndrome may be resistant to diuretics?

Reduced serum proteins Signup and view all the answers

Which of the following is NOT a diagnostic criterion for nephrotic syndrome?

Hypertension Signup and view all the answers

What is a common cause of acute tubular necrosis in patients with nephrotic syndrome?

Volume depletion Signup and view all the answers

What level of serum albumin is considered hypoalbuminemia in the context of nephrotic syndrome?

< 2.5 g per dL Signup and view all the answers

Which class of medications can lead to a hemodynamic response affecting kidney function?

Nonsteroidal anti-inflammatory drugs Signup and view all the answers

Which hyperlipidemia level is often observed in nephrotic syndrome, although it is not required for diagnosis?

Total cholesterol > 350 mg per dL Signup and view all the answers

What is a potential consequence of gastrointestinal absorption issues in severe nephrotic syndrome?

Requirement for intravenous diuretics Signup and view all the answers

Which statement regarding edema in nephrotic syndrome is correct?

Edema can be generalized or localized Signup and view all the answers

Which condition may transform underlying glomerular disease in nephrotic syndrome?

Crescentic nephritis Signup and view all the answers

What must loop diuretics be to be effective in the renal tubule?

Protein-bound Signup and view all the answers

What is a key factor influencing the choice of diuretic administration in patients with nephrotic syndrome?

Severity of edema Signup and view all the answers

Which of the following is NOT a cause of acute kidney injury in nephrotic syndrome?

Increased renal blood flow Signup and view all the answers

What is often indicated in patients with nephrotic syndrome (NS) when considering complications?

Assessment of venous thromboembolic risk only when symptomatic Signup and view all the answers

Which statement correctly summarizes the bacterial infection risks associated with nephrotic syndrome?

There is no current guideline for prophylactic antibiotics in adults with NS Signup and view all the answers

Regarding the overproduction of proteins in nephrotic syndrome, what is accurately described?

It typically results in a loss of low-molecular-weight proteins in urine Signup and view all the answers

What complexity challenges the determination of infection incidence in nephrotic syndrome?

The heterogeneity of clinical manifestations and causes Signup and view all the answers

What does the absence of relevant studies in adults with nephrotic syndrome imply about current knowledge?

There is a lack of evidence to inform clinical management of infections in NS Signup and view all the answers

What type of screening is not generally advised for asymptomatic patients with nephrotic syndrome?

Screening for venous thromboembolic complications Signup and view all the answers

Which factor complicates accurate management of nephrotic syndrome complications?

The absence of standardized treatment protocols Signup and view all the answers

Which conclusion can be drawn about the management of venous thrombosis in patients with nephrotic syndrome?

Its incidence and risk remain difficult to determine Signup and view all the answers

Study Notes

Nephrotic Syndrome Overview

Nephrotic Syndrome (NS) can have various secondary causes, including metabolic, immunologic, neoplastic, and infectious origins.

Secondary Causes of Nephrotic Syndrome

Metabolic: Amyloidosis; Diabetes mellitus; Cryoglobulinemia.
Medication/Drug Use: Heroin; Lithium; Nonsteroidal anti-inflammatory drugs (NSAIDs).
Infections:
- Viral: Epstein-Barr virus; Hepatitis B and C; Herpes zoster; HIV.
- Bacterial: Infective endocarditis; Leprosy; Syphilis.
- Protozoan: Filariasis; Malaria; Schistosomiasis.
- Other: Insect stings, congenital nephrotic syndrome (Finnish type), hereditary nephritis (Alport syndrome), and malignant hypertension.

Complications

Common complications include edema, ascites, periorbital edema, hypertension, pleural effusion, and possible thromboembolic events.
Screening for asymptomatic thromboembolic events is typically not indicated unless there are risk factors.
Bacterial infections, particularly cellulitis, are notable complications.

Diagnostic Criteria for Nephrotic Syndrome

Heavy proteinuria: Protein-to-creatinine ratio > 3 to 3.5 mg/mg or 24-hour urine collection showing > 3 to 3.5 g protein.
Hypoalbuminemia: Serum albumin < 2.5 g/dL.
Edema: Clinical evidence of peripheral edema.
Hyperlipidemia: Severe hyperlipidemia often exceeds total cholesterol > 350 mg/dL.

Treatment of Edema

Patients with nephrosis show resistance to diuretics due to reduced serum proteins, necessitating higher doses of loop diuretics.
Oral loop diuretics with twice-daily administration are preferable; intravenous diuretics may be required in severe cases due to uncertain gastrointestinal absorption.

Overall Management

Diagnosis and management processes are complex; algorithms are available to guide healthcare professionals in treatment decisions.
Biopsy may be reserved for cases with unknown histology or suspected systemic issues, providing critical insights for treatment and prognosis.

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Description

Test your knowledge on the diagnostic criteria for nephrotic syndrome. This quiz covers key factors such as proteinuria and other relevant criteria. Take this opportunity to refresh your understanding of nephrology terms and concepts.