Paediatrics: Nephrotic Syndrome: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Nephrotic Syndrome in Children: High-Yield Paediatric Revision🎧 Your essential audio revision for MSRA, GP trainees, and anyone prepping for paediatric emergencies.🧠 Key Learning Points📌 Definition• Nephrotic syndrome is a paediatric kidney disorder defined by a triad of: – Proteinuria (>1g/m²/day) – Hypoalbuminaemia (<25g/L) – Oedema (often starting periorbitally and spreading)• Caused by increased permeability of the glomerular basement membrane—“leaky filter” lets protein escape into urine.📌 Causes & Risk Factors• Primary causes: – Minimal Change Disease (most common in children, especially ages 2–5) – Focal segmental glomerulosclerosis (FSGS), membranous nephropathy, membranoproliferative GN• Secondary causes: – Infections (bacterial, viral, parasitic), autoimmune (SLE, RA), metabolic (diabetes, amyloid), drugs (NSAIDs, lithium), malignancy, toxins• Risk factors: – Genetic predisposition, preceding infections (especially URTI/skin), allergy, autoimmune disease, certain drugs📌 Pathophysiology• Damage to the glomerular filtration barrier increases permeability.• Large proteins (esp. albumin) lost in urine → hypoalbuminaemia• ↓ Oncotic pressure → fluid shifts into tissues (oedema)• Liver compensates, producing more lipoproteins → hyperlipidaemia• Hypercoagulable state (prone to clots)📌 Clinical Features• Symptoms: – Oedema (periorbital first, then limbs/genitals/abdomen) – Weight gain, reduced urine output, frothy/foamy urine – Fatigue, susceptibility to infections, risk of clots• Signs: – Severe oedema (can cause breathing issues) – Hypovolaemia signs (tachycardia, cold extremities, oliguria) – Xanthomata (cholesterol deposits), Murky’s lines (white fingernail lines)📌 Differential Diagnosis• Acute or chronic glomerulonephritis (blood, hypertension)• Chronic kidney disease• UTI• Systemic diseases (SLE, HSP)📌 Diagnosis & Investigations• Urine dipstick: proteinuria; midstream urine to rule out infection• Quantify protein loss: protein:creatinine/albumin:creatinine ratio• Bloods: U&Es, creatinine, albumin, lipids, FBC, coag, LFTs, autoimmune screen, viral screen (HBV, HCV, HIV), thyroid• Imaging: renal ultrasound, CXR• Renal biopsy if atypical features or steroid resistance📌 Management• Mainstay: Oral corticosteroids (90% respond if minimal change disease)• Relapses/common: other immunosuppressants (cyclosporine, tacrolimus, cyclophosphamide, rituximab, mycophenolate)• Oedema: low-salt diet, loop diuretics, occasional IV albumin, fluid restriction if needed• Monitor: daily weights, BP, urine output• Infection risk: up-to-date vaccinations (pneumococcal, varicella)• Hypertension: ACE inhibitors/ARBs• Lipid-lowering therapy if persistent• Referral: urgent to paediatric nephrology if severe oedema, complications, or steroid resistance📌 Prognosis & Complications• Prognosis: 80% remission with steroids (minimal change disease); relapse common (up to 80%)• Complications: – Infection (pneumonia, peritonitis), thromboembolism (DVT/PE), acute kidney injury – Chronic kidney disease in resistant cases – Bone health issues (osteomalacia, osteoporosis), anaemia, hypothyroidism• Pre-steroid era mortality >50%; now <3% in children📚 Full Paediatric Nephrotic Syndrome MSRA Resources:📝 Revision Notes: https://www.passthemsra.com/topic/nephrotic-syndrome-in-children-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/nephrotic-syndrome-in-children-flashcards/💬 Accordion Q&A: https://www.passthemsra.com/topic/nephrotic-syndrome-in-children-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/nephrotic-syndrome-in-children-rapid-quiz/🎓 Full Course: https://www.passthemsra.com/courses/paediatrics-for-the-msra/#MSRA #NephroticSyndrome #Paediatrics #MSRARevision #GPRevision #MSRAFlashcards #MSRAQuiz #MinimalChangeDisease #ChildHealth #NICEGuidelines #PaedsRenal #Oedema