2. NEPHROTIC SYNDROME
Definition;
• Refers to a clinical syndrome characterized by edema,
massive proteinuria, hyperlipidemia ,and
hypoalbuminemia
• Or NS refers to a condition which causes the kidneys
to swell and release a lot of protein in urine
• NS is most common In childern of 2-6 years (boys)
3. Causes
• Nephrotic syndrome has many causes and may either
be the result of a glomerular disease that can be
either limited to the kidney, called primary nephrotic
syndrome e.g glomerulonephritis
• or
• a condition that affects the kidney and other parts of
the body, called secondary nephrotic syndrome.
4. Causes
• Secondary nephrotic syndrome can be caused by;
• Infections e.g malaria,hiv
• DM
• Leukemia
• Lymphomas
• drug exposure
• SCA
5. Pathophysiology
• The renal glomerulus filters blood that arrives at the kidney.
It is formed of capillaries with small pores that allow small
molecules to pass through that have a molecular weight of
less than 40,000 Daltons, but not larger macromolecules
such as proteins.
• In nephrotic syndrome, the glomeruli are affected by an
inflammation or a hyalinization (the formation of a
homogenous crystalline material within cells) that allows
proteins such as albumin, antithrombin or the
immunoglobulins to pass through the cell membrane and
appear in urine.
6.
7. • Albumin is the main protein in the blood that is able to
maintain an oncotic pressure, which prevents the leakage of
fluid into the extracellular medium and the subsequent
formation of edemas.
• As a response to hypoproteinemia the liver commences a
compensatory mechanism involving the synthesis of
proteins, such as alpha-2 macroglobulin and lipoproteins.
• An increase in the latter can cause the hyperlipidemia
associated with this syndrome.
8. Clinical manifestations
• Edema
• Weight gain due to fluid retention
• Oliguria
• Diarrhoea
• Fatigue
• Sacral pad edema, ankles, hands
• Generalized edema
• Periorbital edema
• Proteinuria hepatosplenomegaly
10. Investigations
• Urinalysis – urine dip stick, rbcs, fumy urine, concentrated
urine,proteinuria
• Blod tests – hypoalbuminemia,hyperlipidemia,creatine /urea
• Kidney biopsy- determines the underlying causes
• Imaging
• Renal sonography
• Renal function test- GFR 120mls/minute is normal
• CBC
11. Management
Mgt goals are;
1. Monitoring fluid intake and out put
2. Improving nutritional intake esp proteins
3. Prevent infection & treatment
4. Restriction of sodium and fats
5. Monitor body weight daily by weighing
6. Promoting skin integrity
7. Promoting energy conservation through bed rest
12. Treatment & medication
• Steriods e.g predinsone 2mg/kg o.d until urine becomes neg
of proteins the reduce the dose to 1.5mg/kg for 4 wks
• Antibiotics
• Diuretics e.g frusemide
• Immunosuppresants e.g cyclophosphamide, cyclosporine,
levamisole
• Vitamin D & calcium
• Anti lipids
13. Complications
• Anemia
• Acute renal failure
• Malnutrition
• Growth retardation
• Pulmonary edema
• Suppression of the immune system
• HTN
