1
Forth stage
Medicine
Lec-5
عماد البدراني
2/11/2015
Glomerular disease
Nephrotic syndrome:
Characterized by excessive proteinuria more than 3.5g/24hr, so low serum
albumin,hypoprotenemia i.e. serum albumin less than 30gm/l with subsequent edema with
or without hyperlipidemia.
Causes of nephrotic syndrome:
1-Non-inflammatory G.N.
a-Minimal change nephropathy.
a-Focal&segmentalglomerulosclerosis.
c-membranous G.N.
2-inflammatoryG.N(proliferative)
a-messangio capillary
b-SLE nephritis
3-systemic disease
a-D.M
b-Amyloidosis
causes and complication of N.S:
1-Edema causes by avid Na retention and hypoalbuminemia, edema accumulates
predominantly in the lower limbs in adults and extending to genitalia and lower abdomen
as it become more sever. In the morning the upper limb and face may be more affected. In
children ascites occur early and edema is often seen in face only.
2-hyper coagulability, due to loss of inhibition of coagulation (anti thrombin 3) this may
lead to D.V.T andrenal vein thrombosis.
3-hypercholesterolemia- may lead to high rate of aterial occlusion.
4-Infection: pt. are liable to infection esp. by pneumococci due to hypogammaglobinemia.
2
Management of nephrotic syndrome; has four elements
1.establish the cause; there is important age – related causes e.g. in neonate congenital
aetiologies are most common , in older children minimal changes nephropathy is the
dominent cause of nephrotic syndrome .
In later life the most cause of nephroic syndrome is membranous nephropathy ,focal
segmental glomerulosclerosis , diabetes mellitus and amyloidosis rarely cause
nephrotic syndrome in childhood ( MOSTLY IN OLDER PATIENTS)
2. Treat the cause of nephrotic syndrome if possible ;
In children with minimal change nephropathy initial treatment with cortico steroid ( 2
mg\kg) for few months and decrease the dose to the half till control of the symptoms
with follow up.
In older patient and in children unresponsive to corticosteroid renal biopsy is
necessary unless there is specific cause (i.e diabetes mellitus , hypertention )
3.treat the symptoms : edema is treated and should be controlled with low- sodium diet
( no added satls) with diuretics , in severe cases of nephrotic syndrome large doses of
combionation of diuretics acting on different parts of nephron may be required ( loop
diuretic plus thiazide plus amiloride).
In occasional patient with evidence of hypovolemia intravenous salt free albumin
infusion may be needed
Over diuresis may lead to renal impairment through hypovolemia
4. prevent complication ; venous thrombosis can be prevented by anticoagulation ,
there is need for routine anticoagulation in all patients with chronic or serverenephrotic
syndrome.
Hypercholestremiais treated with lipid- lowering drugs.
The risk of infection with pneumococci can be prevented with immunization.