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