Nephrotic syndrome (3)
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Nephrotic syndrome (3)

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Nephrotic syndrome (3) Nephrotic syndrome (3) Presentation Transcript

  • NEPHROTIC SYNDROME - A PRESENTATION BY NAYEEM AHMED
  • What is Nephrotic Syndrome ? NEPHROTIC SYNDROME IS A  NONSPECIFIC KIDNEY DISORDER CHARACTERISED  BY A NUMBER OF SIGNS  OF DISEASE: PROTEINURIA, HYPOALBUMINEMIA  AND EDEMA. NEPHROTIC SYNDROME (NS) RESULTS FROM INCREASED PERMEABILITY OF GLOMERULAR BASEMENT MEMBRANE (GBM) TO PLASMA PROTEIN.
  • The Main Trigger Of primary Nephrotic Syndrome and Fundamental and highly important change of pathophysiology :Proteinuria Nephrotic Syndrome (Nephrosis)
  • In Short It is clinical and laboratory syndrome characterized by massive proteinuria, which lead to hypoproteinemia (hypoalbuminemia), hyperlipidemia and pitting edema.
  • NS in a nutshell • Proteinuria • Protenima  (Hypoalbuminemia) • Hyperlipidemia • Generalized edema  (Anasarca) • Oliguria • Hypertension
  • Causes  Amyloidosis :  A group of diseases resulting from abnormal deposition of certain proteins (amyloids) in various bodily areas.  Membranous Glomerulopathy:  Is a kidney disorder that leads to changes and inflammation of the structures inside the kidney that help filter wastes and fluids. Diabetes  Foot Process Disease:  In minimal change disease, there is damage to the glomeruli
  • Classification  Primary Idiopathic NS (INS): majority The cause is still unclear up to now. Recent 10 years evidence has suggested that INS may result from a primary disorder of T– cell function. Accounting for 90% of NS in child.  Secondary NS:  Congenital NS: rare 1st 3 month of life, only treatment renal transplantation.
  • Secondary NS  Drug  Toxicity  Allergy  Infection: HBV, HIV, leprosy, syphilis, Schistosomiasis.  Autoimmune or collagen-vascular diseases  Metabolic disease: Diabetes mellitus.  Neoplasma: Hodgkin’s disease, carcinoma.  Genetic Disease: Sickle cell disease, Amyloidosis, Congenital nephropathy.
  • Idiopathic NS (INS) • Minimal Change Nephropathy (MCN): <80% • Non—Minimal Change Nephropathy :< 20%
  • Some Facts Nephrotic syndrome is 15 times more common in children than in adults. Most cases of primary nephrotic syndrome are in children and are due to minimal-change disease.
  • Nephrotic criteria *Massive proteinuria : qualitative proteinuria: 3+ or 4+, quantitative proteinuria : more than 3.5gms/day in children (selective). *Hypo-proteinemia : total plasma proteins < 5.5g/dl and serum albumin : < 2.5g/dl. *Hyperlipidemia : serum cholesterol : > 5.7mmol/L *Edema : pitting edema in different degree
  • Pathophysiol ogy  Glomerular Damage  Proteinuria  Hypoproteinemia  Edema  Hyperlipidemia
  • Sequelae. because of NS Proteinuria Reduced Albumin Reduced oncotic pressure Edema Reduced blood volume Activation of RAAS Edema
  • Hyperlipidemia; Pathogenesis of: Response to Hypoproteinemia → reflex to liver --→ synthesis of generalize protein ( including lipoprotein ) and lipid in the liver ,the lipoprotein high molecular weight no loss in urine → hyperlipidemia *Diminished catabolism of lipoprotein
  • Clinical Manifestations 1.Main manifestations: Edema (varying degrees) is the common symptom Local edema: edema in face , around eyes( Periorbital swelling) , in lower extremities. Generalized edema (anasarca), edema in penis and scrotum. 2.Non-specific symptoms: Fatigue and lethargy loss of appetite nausea and vomiting abdominal pain diarrhea body weight increase urine output decrease pleural effusion (respiratory distress)
  • Examples of Clinical Menifestations  Periorbital swelling  Anasarca
  • Management of Nephrotic Syndrome General (non specific) *Corticosteroid therapy
  • General (non-specific) Hospitalization Diet : Hypertension and edema: Low salt diet. Severe edema: Restricting fluid intake Avoiding infection Diuresis Vaccination
  • Corticosteroid- Prednisone therapy:  Prednisone is a corticosteroid.  It reduces swelling.  It is used for many conditions among them:  Allergic reactions  Skin diseases  Breathing problems  Certain Cancers  Blood disorders  Eye problems  Hormone replacement
  • Thank you for you Patience and concentration