Let's learn the pharmacology related to nephrotic syndrome - features of nephrotic syndrome with underlying mechanisms, objectives of treatment, and management of the nephrotic syndrome.

1. NEPHROTIC SYNDROME

2. LEARNING OBJECTIVE
• To list the features of nephrotic syndrome with their
underlying mechanisms.
• To define the objectives of treatment of nephrotic
syndrome.
• To describe the management of nephrotic syndrome.

3. NEPHROTIC SYNDROME
Feature Mechanism Consequence
Proteinuria
(> 3.5 g/day )
-Structural damage to glomerular
basement membrane
-Loss of size & charge barrier
-Hypoalbuminemia
Hypoalbuminemia
(<3 g/dl)
-Massive proteinuria
-High catabolism of reabsorbed
albumin (proximal tubule of kidney)
-Reduced oncotic pressure
-Edema
Sodium retention - Secondary hyperaldosteronism -Edema
Hypercholesterolemia -Increased hepatic lipoprotein
synthesis in response to
hypoalbuminemia
-Atherosclerosis
Hypercoagulability -Urinary loss of antithrombin III,
protein C and S
-Increased serum fibrinogen level
-Venous
thromboembolism
Infection -Urinary loss of immunoglobulin -Pneumococcal infection

4. OBJECTIVES OF TREATMENT OF
NEPHROTIC SYNDROME
• To identify the underlying cause and reverse it (if
possible).
• To reduce proteinuria.
• To reduce edema formation.
• To reduce blood cholesterol level.
• To restrict dietary sodium.

5. OBJECTIVES OF TREATMENT OF
NEPHROTIC SYNDROME
• To prevent complications like
- hypercoagulability
- infection
- acute kidney disease
• To maintain electrolyte balance.
• To maintain quality of life.

6. MANAGEMENT OF NEPHROTIC
SYNDROME
Management of
• Edema
• Proteinuria
• Hypercholesterolemia
• Hypercoagulability
• Infection

7. Management of edema
 Dietary sodium restriction
 Thiazide diuretics ( Bendroflumethiazide)
 Furosemide with amiloride -
If unresponsive to thiazide
Parenteral route if resistance to oral diuretic
-Nephrotic patient may malabsorb diuretics owing
to gut mucosal edema

8. Management of proteinuria
Normal protein diet intake
- High protein diet (80-90 g/day) increases
proteinuria
ACE inhibitors and/or angiotensin II antagonist
- Reduces glomerular efferent arteriolar resistance
- Reduces intraglomerular capillary pressure
- Reduces protein filtration

9. Management of hypercholesterolemia
 Lipid lowering drugs
- HMG CoA reductase inhibitors, fibrates
 Restrict saturated and trans-fatty acids in diet
Management of hypercoagulability
 Prolonged bed rest avoided
- Thromboembolism very common in nephrotic syndrome
 Long term prophylactic anticoagulant
- In absence of any contraindications

10. Management of infection
Early detection and aggressive treatment of infection
- Rather than long term antibiotic prophylaxis
Pneumococcal vaccine given
- Pneumococcal infections particularly common

11. REFERENCES
• Davidson’s Principles & Practice of Medicine; 21st
Edition ; page no. 481
• KUMAR & CLARK CLINICAL MEDICINE; 6th
EDITION ; Page no.901-903
• HARRISON’S Principles of INTERNAL
MEDICINE; 17th Edition ; Page no. 1210

12. “THANK YOU”