Nephrotic Syndrome
Title
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Nephrotic Syndrome
Definition
The nephrotic syndrome consists of:
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Heavy proteinuria
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Hypoalbuminaemia
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Oedema
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Hypercholesterolaemia:
Almost always present
Pathogenesis
Causes
Primary
Glomerular Disease
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Minimal change GN
(glomerulonephritis)
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Membranous GN
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Focal segmental
glomerulosclerosis
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Mesangiocapillary GN
Secondary
Glomerular Disease
CVS
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Endocarditis
HS
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Lymphoma
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Leukaemia
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Myeloma
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Amyloid
LMS
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SLE
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Henoch-Schonlein purpura
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Rheumatoid arthritis
E&M
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Diabetes mellitus
Infections
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Malaria
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Hepatitis B
Neoplasia
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Carcinoma
Drugs
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Penicillamine
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Captopril
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Gold
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Intravenous drug abuse
Pathological Process
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Structural damage to the
glomerular basement membrane leads to increased permeability to albumin
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This increase in filtered load
overcomes the ability of the tubules to reabsorb protein
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Hypoalbuminaemia results
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The consequence of
hypoalbuminaemia is oedema
Clinical Features
History
KUS
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Swelling of the body
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Frothy urine
HS
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Recurrent infections
Examination
E&M
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Protein malnutrition
CVS
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Venous thrombosis:
Due to:
Loss of factors such as antithrombin III
Increased production of fibrinogen
IS
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Peripheral oedema
RS
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Pleural effusions
GIT
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Ascites
Investigations
Fluids
Urine
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Proteinuria:
24-hour urinary protein more than 3-5 g
(Grams) daily
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Selective protein clearance:
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Selective
Minimal change nephropathy
Early diabetes mellitus
Amyloidosis
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Unselective leak
Severe glomerulonephritis
Blood
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Serum albumin:
Less than 30 g/dl
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Serum electrophoresis:
Reduced serum albumin
Increase in alpha and beta globulin
Tissue
Diagnosis
Renal biopsy
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Indicated to assess if the cause
is a steroid sensitive lesion
Management
Control
Drugs
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Diuretics
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Steroids
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Cyclophosphamide
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Ciclosporin
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Statins:
Hypercholesterolaemia
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Anticoagulation:
Antithrombin III deficiency
Biological Agents
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Pneumococcal vaccine:
Sepsis common in nephrotic syndrome
Lifestyle Adjustments
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Diet:
High protein diet
