A 6-year-old male child was admitted to the pediatric ward with complaints of cough for 2 days, facial swelling for 10 days, and abdominal distension for 10 days. Laboratory tests found proteinuria, hyperlipidemia, and decreased urine output. The child was diagnosed with nephrotic syndrome and treated with antibiotics, a salt-restricted diet, diuretics, and steroids. Nephrotic syndrome is characterized by proteinuria, hyperlipidemia, edema, and hypoalbuminemia. The causes include minimal change disease, focal segmental glomerulosclerosis, and diabetic nephropathy. Treatment focuses on managing edema, replacing protein loss, lowering lipids, and in some cases using st

1. NIKHIL.V,
Doctor Of Pharmacy,
MGMH,
Wrangal.

2. A male child of age 6 years was admitted into
Pediatric ward with IP number 27289 0n
28/12/2015
SUBJECTIVE FINDINGS
presented with c/o
cough since 2days
facial puffines since 10days
abdominal distension since 10days
Decreased urine output

4. o Haemoglobin - 11.5 gm%
o Sr.creatinine - 0.6 mg/dl
o Urinary protein - 3.8 gm%
o Total cholestrol - 404 mg/dl
o LDL - 300 mg/dl
o HDL - 60 mg/dl
o Triglycerides - 243 mg/dl
o VLDL - 49 mg/dl
o Urine output - 1.5lit
o normal :1ml / kg/hr

5. 28/12/2015
INJ.CEFOTAXIM 560 mg/iv/tid
Salt restriction diet
Tab.MVT
02/01/2016
ADD
TAB. PREDNISOLONE 5mg 3-2-3
04/01/2016
ADD.INJ.AMPICILLIN 400mg/iv/bid

7. Also consider
•HEART FAILURE
•CIRRHOSIS
•CHRONIC GLOMERULONEPHRITIS
•DIABETIC NEPHROPATHY
•MINIMAL CHANGE NEPHROPATHY
•FOCAL SEGMENTAL
GLOMERULOSCLEROSIS
•HIV ASSOCIATED NEPHROPATHY
•RADIATION NEPHROPATHY
•SICKELCELL NEPHROPATHY

8. UNDERSTAND NEPHROTIC SYNDROME
 PHYSIOLOGY
 PATHOGENESIS
 DIAGNOSIS
 TREATMENT
 COUNSELLING
 INTERACTIONS
 INTERVENTIONS

9. NEPHROTIC ? NEPHRITIC

12. NEPHROTIC>LEAKED PODOCYTES>LOSS OF PROTIENS>3.5gm/day>
FROTHY URINE>PROTEINURIA>ALBUMIN KEEPS FLUID IN LUMEN>
ALBUMIN LOSS>FLUID LEAKS>LEGS,LUNGS,FACE EDEMA.
NEPHRITIC>ANTIGEN ANTIBODY COMPLEX>LODGE IN
CAPPILERIES
>ELLICT IMMUNE RESPONSE>RECRUIT WBC>INFLAMMATION>
BREAKDOWN OF BARRIER>PROTIENS, RBC,WBC LEAK>
HEMATURIA
INFFLAMATION

14.  The nephrotic syndrome is a clinical complex
characterised by a number of reanal and
external features , the most prominent are
 Albumin decrease
 Hypercoagulability.
 Hyperlipidemia
 Edema
 Lipiduria
 Proteinuria of ›3.5g/day

15. When the components of the filtration barrier
Are disrupted leads to protein loss and
worsens renal function
Complictions:
o Albumin : edema
o Transferin: anemia
o Vit.D binding globulin :
hypocalcemia>convulsions

16. Due to urinary loss of albumin , liver tries to
Compensate this protein loss by increasing the
synthesis of albumin as well as other
molecules like VLDL nd LDL contributing to
development of Hperlipidemia.
Protien synthesis and lipid accumulation:
http://www.ncbi.nlm.nih.gov/pmc/articles/PM
C2224672/

17. It results from the loss of inhibitors of
coagulation in the urine and increased
synthesis of procoagulatory factors by the
liver.
COMPLICATIONS:
o Renal vein thrombosis
o Peripheral vein thrombosis
o Cerebral vein thrombosis

19.  It is due to a combination of a decrease in
oncotic pressure from the hypoalbuminaemia
as well a primary renal sodium retention in
the collecting tubules.

20. Patients with nephrotic syndrome are at
increased risk of infections due to loss of
immunoglobulins and complement being lost
in the urine.

21.  Minimal change disease- tissue normal under microscope
 Focal segmental glomerulosclerosis- scarring of glomeruli
 Membraneous nephropathy-thickened membrane
 Diabetic kidney disease
 Systemic lupus erythematosus
 Amyloidosis-amyloid build up
 Blod clot in renal vein
 CHF
 are responsible for increasing the glomerular permiability and
protienuria.

22. • Bed rest in edema
•Regulate body water balance by Salt and fluid
restriction depending upon edema
•Replace the protein loss by having intake of protiens,
avoid high intake of protiens to prevent any tubular
damage.
•Fat intake should also be low
•Calcium intake of 800mg/day either by diet or a
tablet with VIT-D is necessary.
•Iron supplementation

23.  Diuretics is a double edge weapon, so use with caution
 Use spironolactone if given with hydrochlorothiazide @
4mg/kg
 NSIDS, ACE inhibitors reduce protienuria
(selective COX2inhibition decreses protienuria:
www.medscpe.com/viewarticle/704078 )
 Vitamin D
 Lipid lowering drugs
 Anticoagulants

24.  Prednisolone 1mg/kg in children as a single or
divided doses for 4 weeks and then single dose
in the morning on alternate days.
 If proteinuria relapses then the child is steroid
dependent , continue prednisolone for 8 weeks
and taper the dose, so that the entire course lasts
for 6 months
 If resistant to prednisolone , cyclophosphamide
2mg/kg, cyclosporin,chlorambucil are used to
retard progression.

25.  Blocks the action of migratory
inhibiting factor (MIF) and chemotactic
factor, inhibits the endothelial
adherence of macrophages and
leukocytes , blocks the antigen
processing function of macrophages,
stablises lysosomal membrne and
prevents the increase in capillary
permiability and diapedesis.

26. GLUCOCORTICOIDS
Cortisol
MINERALOCORTICOIDS
Aldosterone
SEX STEROIDS
Androgens
Estrogens
progestagens

30.  Nephrotic Syndrome is associated with
immune complexes depositing in the kidneys.
When you get fever, cold or infection,
excessive immune complexes come into
being and deposit in the kidneys, triggering
the relapse of Nephrotic Syndrome.
Antibiotics can kill the bacteria invading into
your body so as to reduce their damage to
your body.

31.  If you do not want to use antibiotics, you
should improve your immunity to fight
against infections. In the daily, you should do
some gentle exercise, such as walking,
jogging, yoga and tai chi to strengthen your
immunity. You should also add fresh
vegetables and fruits into your diet, which is
packed with rich vitamins, which can also
boost your immune system