• Nephrotic syndrome vs other high volume states (CHF, cirrhosis)
  • facial edema likely more common in NS than in CHF because patients with heart failure cannot lie flat, ascites tends to be loculated in the abdomen
  • tend to see hyponatremia in CHF and cirrhosis due to normal functioning kidneys in the presence of activated RAS system, but not as much in nephrotic syndrome as the kidneys are not functioning normally
  
  

  Posted 04/20/17 09:45:20 AM by Anna Krigel

• NSAID-induced renal injury
  • NSAIDs inhibit COX enzymes, which in turn causes decreased PG synthesis, which blocks the vasodilatory effect of PG on the afferent arteriole resulting in reduced GFR
  • Multiple renal syndromes are associated with NSAIDs
    • AKI
    • AIN
    • Nephrotic syndrome - can be via minimal change disease or membranous nephropathy
    • Hyperkalemia/Type 4 RTA 
    • Hypertension/edema
    • Acute papillary necrosis 
  
  

  Posted 04/20/17 10:24:27 AM by Anna Krigel

• Nephrotic syndrome etiologies
  • FSGS - focal segmental glomerulosclerosis, most common cause in African-Americans, also associated with HIV and viral hepatitis
  • Minimal change disease – can be associated with NSAID use or a paraneoplastic effect of malignancy (most commonly Hodgkin lymphoma)
  • Membranous nephropathy – most common cause of primary nephrotic syndrome in adults, can also be associated with secondary causes like malignancy, autoimmune diseases, and NSAID use
  • Amyloidosis – AL or primary vs AA or secondary
  • Diabetes – usually after years of poor control
  
  

  Posted 04/20/17 10:31:15 AM by Anna Krigel

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