⚕️ FREE MSRA PODCAST – Nephrotic Syndrome
🎧 A clear, high-yield breakdown of this renal condition causing massive proteinuria and oedema – perfect for exam prep and real-life clinical scenarios.

🧠 Key Learning Points

📌 Definition
• Nephrotic syndrome is a glomerular disorder marked by:
– Heavy proteinuria >3.5g/24h
– Hypoalbuminaemia <30g/L
– Oedema
– Hyperlipidaemia

📌 Causes & Risk Factors
• Primary renal causes:
– Minimal change disease (esp. in children)
– FSGS (focal segmental glomerulosclerosis)
– Membranous nephropathy
– Membranoproliferative GN
• Secondary causes:
– Diabetes, SLE, amyloidosis
– Infections: Hep B/C, HIV, malaria
– Malignancy: myeloma, lymphoma
– Drugs: NSAIDs, captopril
– Pregnancy (pre-eclampsia), transplant rejection
🧠 Mnemonic: “HOPED” – Heavy proteinuria, Oedema, low Protein (albumin), Elevated lipids, Differential causes

📌 Pathophysiology
• Glomerular damage → increased permeability
• Albumin leaks → ↓ oncotic pressure → fluid shifts → oedema
• Liver compensates → ↑ lipoprotein synthesis → hyperlipidaemia
• Immunoglobulin & antithrombin loss → infection + clot risk

📌 Symptoms
• Generalised oedema: ankles, periorbital, ascites
• Foamy urine (from proteinuria)
• Fatigue, weight gain
• SOB (pleural effusion), oliguria
• In children: delayed growth/puberty
🧠 Pearl: Look for “Muehrcke’s lines” – transverse white nail bands in hypoalbuminaemia

📌 Differential Diagnosis
• Acute glomerulonephritis
• CKD
• Diabetic nephropathy
• Cardiac/liver failure (causing oedema)
• Protein-losing enteropathy

📌 Diagnosis
• Urine:
– Dipstick: +++ protein
– PCR or ACR (spot or 24h)
– Urine microscopy: fatty casts
• Bloods:
– ↓ Albumin, ↑ lipids
– U&Es, LFTs, immunology (ANA, complement, serum light chains)
• Imaging:
– Renal US
– CXR (pleural effusion)
• Renal biopsy:
– Essential in adults to define glomerular disease
– Often not needed in typical paediatric minimal change disease

📌 Management
• Treat underlying cause
• Corticosteroids – 1st line for minimal change
• Other immunosuppressants: cyclophosphamide, mycophenolate, tacrolimus
• ACEi/ARBs: reduce proteinuria + control BP
• Diuretics: loop diuretics ± thiazides for oedema
• Statins for hyperlipidaemia
• Anticoagulation if VTE or high clot risk
• IV albumin: only for severe hypoalbuminaemia
• Vaccination: pneumococcal, varicella
• Diet: salt restriction, fluid restriction, weight monitoring
• Daily weights + leg elevation helpful in oedema control
• Urgent nephrology referral always indicated

📌 Complications
• Thromboembolism (DVT, renal vein thrombosis)
• Infections (due to immunoglobulin loss + immunosuppression)
• Acute kidney injury
• Chronic kidney disease/ESRD
• Hypocalcaemia, bone disease, hypothyroidism, anaemia

📌 Prognosis
• Minimal change disease: excellent in children, remission likely
• FSGS: ~50% adults progress to ESRD in 5–10 years
• Depends on underlying cause and response to therapy
• Early diagnosis and tailored management are key to outcome

📎 More MSRA Resources for Nephrotic Syndrome
📝 Revision Notes:
https://www.passthemsra.com/topic/nephrotic-syndrome-revision-notes/

🧠 Flashcards:
https://www.passthemsra.com/topic/nephrotic-syndrome-flashcards/

💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/nephrotic-syndrome-accordion-qa-notes/

🚀 Rapid Quiz:
https://www.passthemsra.com/topic/nephrotic-syndrome-rapid-quiz/

🧪 Topic Quiz:
https://www.passthemsra.com/quizzes/nephrotic-syndrome/

🎓 Full Course:
https://www.passthemsra.com/courses/renal-for-the-msra/

📣 All resources are part of the Renal for the MSRA course at
https://www.passthemsra.com – your hub for high-yield, NICE-based revision 🚀

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