Wednesday, 8 September 2010

MRCP revision battle 5.1: Nephrotic Syndrome

After yesterdays big push today's revision was less epic, mainly because I started reading "The Lovely Bones" by Alice Sebold and I just got too involved.  My motivation to revise also wasn't helped by the first onexamination question I did being 'renal based', with renal medicine being my personal black hole of knowledge... it doesn't matter how many facts I try to throw into it, it still remains just as black.

So, today's battles are:
5.1 nephrotic syndrome
5.2 renal vein thrombosis
5.3 IgA glomerulonephritis
5.4 acute epiglottis

Battle 5.1: Nephrotic syndrome

Nephrotic syndrome is a classic triad of:
  • >3g proteinuria
  • hypoalbuminaemia <25 and
  • oedema
It is also strongly associated with hypercholesterolaemia

80% of the time it is associated with glomerulonephritis, a fiendishly complex set of conditions.

The rest of the time its possible causes are many and varied:
  • diabetes mellitus
  • leprosy/malaria/HBV
  • myeloma/lymphoma
  • amyloidosis
  • SLE
  • gold/penicillamine/NSAIDS/captopril/interferon alpha/heroin
  • pre-eclampsia
  • accelerated hypertension
  • sickle cell disease
  • Alports
  • rarely visico-ureteric reflux
I'm afraid I don't have a clever way/inclination to remember that list, I just hope that by reading it a few times in the exam a faint light of recognition may go on at the appropriate time.

Happily I do have a way of remembering the potential complications of nephrotic syndrome, which is good since sneaky MRCP examiners may be trying to get you to guess nephrotic syndrome from a description of the complications alongside part of the classic triad.

My mnemoric is BOB, I HIT HIM:
  • B12 deficiency
  • Osteomalacia
  • Budd-Chiari
  • Infections
  • Hyperlipidaemia
  • Immunosupression
  • Thrombosis (including renal vein thrombosis)
  • Hyponatraemia
  • Iron deficiency
  • Malnutrition

Treatment for nephrotic syndrome is to restrict salt, treat the cause, prophylactic heparin, treat any hypertension and potentially give furosemide or ACE-i.

On to 5.2... renal vein thrombosis