Thread by @BMCimRES

#ICYMI, CMR @HelyShahMD took us through a case of nephrotic syndrome last week and explored the various complications of nephrotic syndrome based on what protein is lost in the urine. Here’s a quick review of some of her teaching points!

#MedTwitter #MorningReport

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1️⃣ Spot urine protein/creatinine ratio correlates well with 24hr urine collection (except for patients with high protein excretion). Easier to collect than 24hr urine!

2️⃣ Urine specific gravity can falsely over- or underestimate proteinuria

pubmed.ncbi.nlm.nih.gov/16756640/

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3️⃣ Nephrotic syndrome is associated with several complications based on what protein is lost in the urine (some impromptu whiteboard teaching from the residents seen here!)

Here are four of these complications:

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Hyperlipidemia – loss of LDL receptor leading to:
⬇️ intrahepatic cholesterol
⬆️ HMG-CoA reductase
⬆️ increase in LDL cholesterol

Hypocalcemia - loss of 1-alpha hydroxylase (catalyzes 25-OH vitD -> 1,25-OH vitD)
⬇️ 1,25-OH vitD
⬇️ calcium absorption

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Hypothyroidism - loss of T4-binding globulin (TBG) and other thyroid hormone binding proteins (transthyretin and albumin)
⬇️ T4 concentrations
⬆️ TSH
Does not affect free T4, so patients are usually still clinically euthyroid!

Iron⬇️ - loss of EPO and transferrin