Nephrotic syndrome, common cause of nephrotic syndrome, typical symptoms of nephrotic syndrome, laboratory findings, treatment and complications of nephrotic syndrome

 

Nephrotic syndrome

It is a glomerular syndrome characterized by...

1.overt proteinuria(›3.5gm/24 hour)

2.hupoalbuminaemia(<30 gm/l)

3.generalized edema.

Typical/common causes of nephrotic syndrome::

    A.. primary glomerular cause

   

1.membranous glomerulopathy

2.minimal change disease

3.focal segmental glomerulosclerosis

4.membrano-proliferative glomerulonephritis

   B.. secondary/systemic cause

1.systemic disease--diabetis, amyloidosis,SLE

2.drugs--NSAIDs, penicillamine, street heroin

3.infextions--malaria,syphilis, hepatitis b&c,HIV

4.malignant disease--carcinoma,lymphoma

5.miscellaneous--allergy, hereditary nephritis

TYPICAL SYMPTOMS OF NEPHROTIC SYNDROME

1.generalized swelling of body

2.anorexia

3.weakness

4.abdominal pain

5.diarrhoea

6.burning sensation during micturition.

SIGNS OF NEPHROTIC SYNDROME

  A..generat examination:

  >Pitting edema (periorbital then generalized)

>blood pressure::normal.

>Anaemia--may be present.

>Leukonychia.

    B..systemic examination:

1.alementary:ascites

2.respiratory: bilateral pleural effusion.

3.cardiovasvular:pericardial effusion.

LABORATORY FINDINGS

A.urinary findings:

>Proteinuria:3+ or 4+

>24 hours protein in urine: massive proteinuria.(child >1gm/m2/24 hours.  &Adult >3.5 gm/24 hours)

>Hyaline casts.

B..serum findings:

>Serum cholesterol level-increased.

>Albumon--decreased

>Serum c3--normal.

C..renal biopsy in steroid resistant cases.

TREATMENT OF NEPHROTIC SYNDROME

1.Supportive care:..

*Diet-balanced diet edequat in protein and calories

*Fluid and salt are restricted

*If severe edema-then diuretics.

*Physical activity-as tolerable.

*Prophylactic daily oral penicillin.

*Treatment of complication.

2.. Specific treatment:

     Initial attack---

*Prednisone -60mg/m2 body surface....daily....6 weeks.

*Then 40mg/me body surface...single morning dose... every alternate day....next 6 weeks.

      Relapse case---

*Prednisone 60 mg/m2 body surface..daily... until nill or trace urinary protein..for 3 consecutive day.

*Then 40 mg/me body surface..single morning dose.. every alternative day...next 6 weeks.

*Prednisone slowly tapered & discontinued over next 2-3 months.

COMPLICATIONS OF NEPHROTIC SYNDROME

1.hypoalbuminaemia.

2.sodium retention.

3.hypercholesterolaemia.

4. Hypercoagulability

5. Infection::sponteneous peritonitis, pneumococcal sepsis, cellulitis, pneumonia,UTI.

6.thromboembolism--(cause of death).