Scribd Logo
Upload

Welcome to Scribd!

  • 29 views

    Nephrotic Syndrome

    Uploaded by

    Jawad Saleem
    Nephrotic syndrome is a kidney disorder characterized by protein in the urine, low albumin levels, edema, and high cholesterol. It is caused by damage to the glomeruli in the kidneys and can be due to primary kidney diseases like minimal change disease or secondary causes like diabetes. Symptoms include edema, weight gain, foamy urine, and tiredness. Treatment involves immunosuppressant drugs like corticosteroids as well as managing complications through blood pressure medications, statins, and antibiotics. The goal of treatment is achieving remission by reducing protein in the urine through medication and lifestyle changes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content

    Nephrotic Syndrome

    Uploaded by

    Jawad Saleem
    29 views24 pages
    Nephrotic syndrome is a kidney disorder characterized by protein in the urine, low albumin levels, edema, and high cholesterol. It is caused by damage to the glomeruli in the kidneys and can be due to primary kidney diseases like minimal change disease or secondary causes like diabetes. Symptoms include edema, weight gain, foamy urine, and tiredness. Treatment involves immunosuppressant drugs like corticosteroids as well as managing complications through blood pressure medications, statins, and antibiotics. The goal of treatment is achieving remission by reducing protein in the urine through medication and lifestyle changes.

    Original Description:

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Nephrotic syndrome is a kidney disorder characterized by protein in the urine, low albumin levels, edema, and high cholesterol. It is caused by damage to the glomeruli in the kidneys and can be due to primary kidney diseases like minimal change disease or secondary causes like diabetes. Symptoms include edema, weight gain, foamy urine, and tiredness. Treatment involves immunosuppressant drugs like corticosteroids as well as managing complications through blood pressure medications, statins, and antibiotics. The goal of treatment is achieving remission by reducing protein in the urine through medication and lifestyle changes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    29 views24 pages

    Nephrotic Syndrome

    Uploaded by

    Jawad Saleem
    Nephrotic syndrome is a kidney disorder characterized by protein in the urine, low albumin levels, edema, and high cholesterol. It is caused by damage to the glomeruli in the kidneys and can be due to primary kidney diseases like minimal change disease or secondary causes like diabetes. Symptoms include edema, weight gain, foamy urine, and tiredness. Treatment involves immunosuppressant drugs like corticosteroids as well as managing complications through blood pressure medications, statins, and antibiotics. The goal of treatment is achieving remission by reducing protein in the urine through medication and lifestyle changes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 24

    NEPHROTIC

    SYNDROME
    By Ms. Seemab Ashraf
    DEFINITION
    Nephrotic syndrome is a group of symptoms that indicates the improper
    functioning of the kidneys. It is characterized by abnormal functioning of the
    glomeruli leading to
    ₪ Proteinuria (> 3.5g/day or >40mg/m2/hr in children)
    ₪ Hypoalbuminemia (<2.5 g/dL)
    ₪ Edema and
    ₪ Hyperlipidemia (> 200mg/dL)
    EPIDEMIOLOGY
    ₪ In children, the annual incidence of nephrotic syndrome is 2-7 cases per
    100,000
    ₪ Most children receive diagnosis between the ages of 2 and 6.
    ₪ MCD is the most common cause of Nephrotic Syndrome in children,
    associated with 80 to 90% of cases.
    ₪ In adults, the annual incidence is 3 per 100,000.
    PATHOPHYSIOLOGY Alteration in the glomerular basement
    membrane or podocytes

    Altered glomerular protein


    permeability

    Increased proteinuria

    Decreased Vascular Decreased colloidal osmotic


    pressure Edema
    volume

    Decreased renal blood Activation of Renin-Angiotensin Tubular Na and H2O


    flow Aldosterone System reabsorption
    CAUSES
    Nephrotic syndrome is usually caused by damage to the glomeruli of the
    kidneys which can occur due to multiple causes:
    ₪ Primary Causes: Being a disease specific to kidneys
    ₪ Secondary Causes: Being a renal manifestation of a systemic general
    illness
    PRIMARY CAUSES
    ₪ Minimal change disease: Most often idiopathic, can be triggered by a recent
    infection, or by an immune stimulus. T cells release factors that target the podocytes
    which leads to loss of negatively charged coat, eventually allowing negatively
    charged molecules, like albumin to enter nephron.
    ₪ Focal segmental glomerulosclerosis (FSGS): More common in adults. It is
    characterized by scarring of some of the glomeruli which can be idiopathic, hereditary
    or due to HIV infection or certain drugs.
    ₪ Membranous nephropathy (Membranous glomerulonephritis): An autoimmune
    dirorder due to sub-epithelial deposits of immune complexes which causes thickening
    of glomerular basement membranes. It can be primary or secondary due to
    malignancy, infectious disease, or an autoimmune disorder.
    SECONDARY CAUSES
    ₪ Diabetes Mellitus
    ₪ Systemic Lupus Erythematosus
    ₪ Amyloidosis
    ₪ Infections, such as HIV/AIDS, hepatitis B, and hepatitis C
    ₪ Allergic reactions
    ₪ Medicines, such as NSAIDs, heroin, interferon-alfa
    ₪ Pre-eclampsia
    ₪ Malignant diseases
    ₪ Genetic disorders
    SYMPTOMS
    ₪ Peripheral edema, ascites and periorbital edema
    ₪ Weight gain due to generalized edema
    ₪ Foamy urine
    ₪ Tiredness
    ₪ Breathlessness (Pleural effusion)
    ₪ Loss of appetite
    COMPLICATIONS
    Nephrotic syndrome can lead to serious complications, including:
    ₪ Thrombotic and thromboembolic complications due to loss of anti-
    coagulant proteins
    ₪ Microcytic hypochromic anemia due to loss of iron-carrying proteins
    ₪ Infections due to loss of immunoglobulins
    ₪ Loss of calcium and vitamin D
    ₪ Hypertension
    ₪ Hyperlipidemia
    ₪ CKD and acute kidney failure
    DIAGNOSIS
    ₪ Urinanalysis:
    Urine dipstick test to check albumin (3+ or 4+)
    24-hour urine collection
    Morning urine protein-to-creatinine ratio (UACR) > 2
    ₪ Blood tests: Albumin, Cholesterol, BUN, creatinine
    ₪ Serological Studies
    ₪ Kidney ultrasound
    ₪ Kidney biopsy
    PHARMACOLOGICAL TREATMENT
    ₪ Immunosuppressants: Corticosteroids are used. Other medications include
    rituximab, cyclosporine and cyclophosphamide.
    ₪ Antihypertensives and reduced proteinuria: ACE inhibitors like lisinopril (Zestril),
    captopril, enalapril and ARBs including losartan and valsartan (Diovan).
    ₪ Hyperlipidemia: Statins include atorvastatin (Lipitor), pravastatin, and simvastatin.
    ₪ Hyper-coagulation: Heparin, warfarin, apixaban
    ₪ Infections: Antibiotics
    ₪ IV Albumin
    PHARMACOLOGICAL TREATMENT
    ₪ Corticosteroids-Mainstay of Therapy
    Initial Episode:
    Oral Prednisolone at a dose of 2mg/kg/day (max. 60mg in single or
    divided doses) for 6 weeks, followed by 1.5mg/kg (max. 40mg) as a single
    morning dose on alternate days for the next 6 weeks; therapy is then
    discontinued.
    PHARMACOLOGICAL TREATMENT
    ₪ Edema Management:
    Furosemide (1-3mg/kg/day)
    May add spironolactone (2-4mg/kg/day) if no response (no weight loss or
    diuresis in 48 hrs)
    Add Hydrochlorothiazide (1-2mg/kg/day) or metolazone
    Achieving a satisfactory diuresis is difficult when the patient's serum
    albumin level is less than 1.5 g/dL. IV Albumin (0.5-1g/kg) followed by IV
    furosemide (1-2mg/kg) can be given.
    Monitor volume depletion
    IMPORTANT DEFINITIONS
    ₪ Response: Remission within the initial 4 weeks of corticosteroid therapy.
    ₪ Remission: Urine albumin nil or trace (or proteinuria <4 mg/m2/h) for 3
    consecutive early morning specimens.
    ₪ Relapse: Urine albumin 3+ or 4+ (or proteinuria >40 mg/m2/h) for 3
    consecutive early morning specimens, having been in remission
    previously.
    ₪ Frequent relapses: Two or more relapses in initial six months or more than
    three relapses in any twelve months.
    IMPORTANT DEFINITIONS
    ₪ Steroid dependence: Two consecutive relapses when on alternate day
    steroids or within 14 days of its discontinuation.
    ₪ Steroid resistance: Absence of remission despite therapy with daily
    prednisolone at a dose of 2 mg/kg per day for 4 weeks
    RELAPSE TREATMENT
    ₪ Prednisolone 2 mg/kg/day (single or divided doses) till remission and then
    prednisolone 1.5 mg/kg/day (single morning dose) on alternate days for 4
    weeks and then discontinued.
    ₪ The usual duration of treatment for relapse is 5-6 weeks.
    FREQUENT RELAPSES, STEROID DEPENDENCE
    Alternate days steroid therapy (9-18 months) for frequent relapse
    OR
    Other Immunosuppressive medications: For those not responding to steroid
    therapy, have frequent relapses or steroid dependence
    ₪ Levamisole or
    ₪ Cyclophosphamide or
    ₪ Calcineurin inhibitor : Cyclosporin, Tacrolimus or
    ₪ Mycophenolate mofetil (MMF) or
    ₪ Rituximab
    AND
    ₪ ACE Inhibitors or ARBs
    STEROID RESISTANT
    ₪ Define therapy based on renal biopsy findings
    ₪ Immunosuppressive therapy
    SPECIFIC TREATMENT
    ₪ Minimal Change Disease: Mostly responds well to prednisolone
    ₪ Focal Segmental Glomerulosclerosis: Prednisolone should be the first-line agent,
    with cyclophosphamide or cyclosporine as backup for steroid-resistant cases.
    ₪ Idiopathic Membranous Nephropathy: Management with angiotensin blockade but
    without immunosuppression can be used for the first 6 months in patients at low risk
    for progression (with serum creatinine <1.5mg/dL). Patients with renal insufficiency
    are at risk of ESRD and should receive immunosuppressive therapy. This includes
    regimens that combine prednisolone with cyclophosphamide.
    NON-PHARMACOLOGICAL TREATMENT
    ₪ Limit intake of sodium and fluids to help control swelling
    ₪ Reduce saturated fat and cholesterol in the diet
    ₪ Lean protein diet
    IMMUNIZATION
    ₪ Pneumococcal Vaccination
    ₪ Influenza Vaccination
    THANK
    YOU

    You might also like