1 / 13

NEPHROTIC SYNDROME

NEPHROTIC SYNDROME. AETIOLOGY,DIAGNOSIS AND MANAGEMENT. INTRODUCTION. NS is a syndrome comprising of heavy proteinuria, (>3g/24 hrs), hypoalbuminemia(alb <30g/L) and oedema.Hypercholesterol other features: Lipiduria, ↑renal catabolism, hypercoagulability.

gisela
Download Presentation

NEPHROTIC SYNDROME

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NEPHROTIC SYNDROME AETIOLOGY,DIAGNOSIS AND MANAGEMENT

  2. INTRODUCTION. • NS is a syndrome comprising of heavy proteinuria, (>3g/24 hrs), hypoalbuminemia(alb <30g/L) and oedema.Hypercholesterol other features: Lipiduria, ↑renal catabolism,hypercoagulability. • Key components: Proteinuria. Results from altered permeability of the GF barriers for protein ie GBM, podocytes and their slit diaphragm.

  3. Contd. • Underfilling hypothesis. ↓ protein →↓ oncotic P0 → leakage of fluid to interstitium → ↓intravascular vol. → stimulation of RAAS, synthesis and release of vasopressin (ADH), supp. of atria natriuretic peptide release. All lead to restoration of IVS → further leakage.

  4. AETIOLOGY • Primary NS. • Secondary NS. • Primary : • Minimal change glomerular DZ. 20%. No progression to chronic renal failure. • Focal segmental glomerulosclerosis.15 – 25% • Membranous Glomerulopathy 30 - 40 %. Peak 30 – 50 yrs. • Membranoproliperative GN. 20 – 30 %. • Fibrillary – immunotactoid 1%. • Mesangial proliferative GN. 5 – 10%

  5. Contd. • Secondary NS. • DM • Sickle cell nephropathy. • Amyloidosis. MM. • Systemic vasculitides – SLE, HSP, GPD. • Drugs: Penicillamine, Captopril, Probenecid trimethadione, mercury, chlormethiazole. • Allergies. Bee stings, hays, etc. • Malignancies. Malignant lymphoproliferative disorders

  6. DIAGNOSIS. • History. • Exposure to drugs, allergies, family hx. Atopy. • Acute or chronic infections. • Frothy urine. • Systemic symptoms. Fever, wt. loss.

  7. Contd. • Examination. • Oedema: leg, arm, face. • Ascites, hepatomegaly, pleural effussion. • ↑ BP in some. • Xanthelasma, Xanthomata. • Features of underlying disorders – SLE, HSP,DM, SCD, malignancies.

  8. Contd. • Investigations. • Urine. • Dipstick (Haematuria, proteinuria) • Microscopy (RBCs, Casts), culture and sensitivity • 24 hr. urine collection. • Urine electrophoresis • Blood. • FBC + ESR or CRP • SEUC • LFT

  9. contd • Lipid profile • HBsAg, HCV • FBS + 2HPP • ASO titres • Throat swab • Serum C3 complement • Selective protein clearance; IgG/ alb or trans • Serum protein

  10. Contd. • Serum electrophoresis. • Immunoglobulins. • Serum ANA, ANCA, anti GBM antibodies. • Cryoglobulinaemia. • Immaging. • CXR • Renal ultrasound. • Renal biopsy.

  11. TREATMENT • Monitor SEUC, BP, Fluid balance, wt. • Fluid restriction (1 – 1.5 L/day.) • Salt restriction 5gm/day. • Normal protein approx. 1g/24hrs of HBV. • Diuretics – frusemide, thiazides, spironolactone ± salt poor alb. • Treatment for HBP • Treat proteinuria • Treat infxn. Prophylaxis. • Prophylactic heparin, warfarin, ± streptokinase.

  12. Contd. • Corticosteroids • Immunomodulators.

  13. COMPLICATIONS • Hyperlipidaemia • Hypercoagulability: antithrombin III, protein s and c, hyperfibrinogenaemia ( ↑ hepatic synthesis), impaired fibrinolysis, ↑ platelet aggregation. • Renal vein thrombosis.(memb. Memb.pro.and amyloidosis. • ARF • Hypocalcaemia & 20 hyperparathyroidism: Loss of cholecalciferol binding protein → Vit D Deff. • Infections. IgG loss. • Others : ↓ thyroxine, protein mal., Fe. Rest. anae

More Related