Basics of Nephrotic Syndrome
Which Protein is lost in large amounts in the urine in nephrotic syndrome?
Albumin
What is nephrotic range proteinuria?
> or = 3.5g/day
>40mg/m2/hour OR
1000mg/m2/day OR
Urine Protein- Creatinine ratio of > or = 2
Which dietary restriction is advised to manage edema in nephrotic syndrome?
Salt restriction
With which complication of nephrotic syndrome does a patient present with abdominal pain and fever?
Spontaneous bacterial peritonitis
At which site do you see edema characteristically in children with nephrotic syndrome?
Periorbital (facial) edema
Define hypoalbuminemia in nephrotic syndrome
Serum albumin < 2.5gm/dl
Mention one second-line drug for the treatment of steroid-dependent nephrotic syndrome.
Cyclophosphamide, Levamisole, and Mycophenolate Mofetil.
Nephrotic patients are at increased risk for which vascular complication?
Deep vein thrombosis (or thromboembolism)
Which is the most common type of nephrotic syndrome in children?
Minimal change disease.
Which is the most accurate investigation to quantify proteinuria?
24‑hour urine protein measurement.
Which medication is the mainstay of treatment in minimal change disease? Provide dose and duration.
Oral prednisolone at a dose of 2mg/kg/day for 6 weeks, followed by 1.5mg/kg/day on alternate days for 6 weeks.
Please mention if the following assertion and reason are True or False. And provide explanation
Assertion (A): Children with nephrotic syndrome are more prone to infections.
Reason (R): There is urinary loss of immunoglobulins and complement factors.
A and R are both true, and R is the correct explanation of A.
Explanation: Immune deficiencies due to urinary loss of immunoglobulins and complement predispose nephrotic children to infections.
Which defect in the nephron leads to heavy proteinuria in nephrotic syndrome?
Effacement of podocytes at the glomerular basement membrane.
Which investigation should be avoided in a typical presentation of nephrotic syndrome? and why?
Renal biopsy, as it is not mandatory to confirm the diagnosis before starting treatment.
Which vaccines should not be administered during the treatment of nephrotic syndrome? Please provide the names of the vaccines.
OPV, BCG, MR, Rotavirus.
Please mention if the Assertion and reason are true or false. And provide explanation.
Assertion (A): Minimal change disease has an excellent prognosis in children.
Reason (R): It is usually resistant to steroid therapy.
A is TRUE and R is false.
Explanation: Minimal change disease is the most common cause of nephrotic syndrome and is highly steroid-responsive, with a good prognosis.
What is the classic tetrad of symptoms seen in nephrotic syndrome?
Heavy proteinuria, Hypoalbuminemia, Odema, and Hyperlipidemia.
Please mention if the assertion and reason are True or False. And provide an explanation
Assertion (A): Serum cholesterol levels are decreased in nephrotic syndrome.
Reason (R): The liver reduces lipoprotein synthesis in response to protein loss.
A and R are both false.
Explanation: Serum cholesterol levels are increased due to compensatory hepatic lipoprotein synthesis triggered by hypoalbuminemia.
Mention complications of long term steroid therapy.
Cushingoid facies
Short stature, Hypertension, Osteoporosis,Raised intraocular pressure,Cataract
Define steroid-resistant nephrotic syndrome. Mention agents for its management.
Definition: Lack of remission despite treatment with prednisolone at a dose of 2mg/kg/day for 6 weeks
Agents: Cyclosporine, Tacrolimus, cyclophosphamide, and rituximab