Nephrotic syndrome

227 Nephrotic syndrome



Instruction


Look at this patient.



Salient features



History




• History of diabetes (N Engl J Med 1998;338:1202–11)


• Hypertension


• History of acute glomerulonephritis, streptococcal sore throat


• Medications: NSAIDs, captopril, street heroin, gold, pencillamine, lithium, chlorpropamide, rifampin, tolbutamide


• History of SLE, vasculitides, amyloidosis


• Neoplasms: Hodgkin’s and other lymphoma, solid tumours


• Familial history: sickle cell disease, partial lipodystrophy (p. 611), Alports syndrome


• Parasites: malaria, toxoplasmosis, schistosomiasis.



Examination




• Generalized oedema: puffiness of face, pitting oedema of legs and hands


• Look at the nails for ridges of hypoproteinaemia


• Comment on the pallor


• Tell the examiner that you would like to examine:


• the abdomen for ascites

• the urine for protein and sugar.

Note: Urine microscopy may show oval fat bodies, which consist of degenerating tubular epithelial cells having cholesteryl esters; these appear as ‘grape clusters’ with light microscopy and have a ‘Maltese-cross’ appearance under polarized light.



Diagnosis


This patient has nephrotic syndrome (lesion) caused by diabetes mellitus (aetiology), and has developed gross anasarca indicating hypoalbuminaemia and marked urinary protein loss (functional status).



Questions




What do you understand by the term nephrotic syndrome?


It consists of albuminuria (>3.5 g/day) and hypoalbuminaemia accompanied by generalized oedema, hyperlipidaemia (caused by increased hepatic production) and lipiduria.

Related posts:

  1. Dermatomyositis
  2. Dystrophia myotonica
  3. Erythema multiforme
  4. Anaemia

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Nephrotic syndrome

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