NEPHROTIC SYNDROME

NEPHROTIC SYNDROME

  • Massive proteinuria > 3.5 g/day
  • Hypo albuminemia serum albumin < 2.5 gm%
  • oncotic pressure decreased - oedema
  • Increased lipids → accelerated atherosclerosis 
↓
- SLE (systemic lupus erythematosus)
- APLAS (Antiphospholipid antibodies syndrome)
- Syndrome X
- DM
- Hypothyroidism
  • Lipiduria - oral fat globules - CHYLURIA (FILARIASIS), fat embolism
  • Loss of protein -  C/S/ Anti thrombin III / Loss of albumin/ ferritin/ceruloplasmin
  • fibrinogen - Normal/increased as it is also an acute phase reactant
- state of HYPER COAGULABILITY - VTE(Venous thrombo embolism)

ETIOLOGY
  • Adults - FSGS (focal segmental glomerulo sclerosis)
  • prediliction : nephrons at cortico medullary junction
  • hence, always a possibility of diagnosis missed on kidney biopsy
CLINICAL FEATURES
  • Hematuria/cola colour urine
  • hypertension - headache
  • nephrotic range proteinuria - foamy urine


  • renal in sufficiency (50%cases) in 6-8 yrs
ETIOLOGY
  • Idiopathic
  • infection: HIV,HBV,Human parvo virus
reflux nephropathy,hypertensive nephropathy,heroin addiction,pamidronate,Alport,sickle cell anemia
 


WORK UP:
  • KFT(kidney function test) - serum creatinine
  • urine microscopic examination : > 3RBC/HPF (NORMAL - <3RBC/HPF)
  • Biopsy kidney cotico medullary junction
eosinophilic deposits
hyper cellularity of  glomerulus
  • electron microscope - hyaline deposits
podocytes foot process - effacement of podocytes,vacuolization,detachment


MANAGEMENT
  • Primary - ACE inhibitors - HTN
  • PROTEINURIA - steroids for 4 -16 weeks or until complete remission
  • FSGS - treat the cause

Comments

Post a Comment

Popular posts from this blog

HYPOKALEMIA(electrolyte imbalance)

Image
HYPOKALEMIA It is a low level of potassium(k ๋) in blood serum normal potassium level 3.5 - 5mmol/L Death can occur due to  respiratory muscle paralysis CAUSES: Decrease intake Alkalosis : Potassium shift into cells Sympathomimetics stimulation - trauma, thyrotoxic periodic paralysis, beta 2 agonist toxicity(salbutamol) Renal loss - excess aldosterone = conn's syndrome,bilateral adrenal hyperplasia, ascites , CHF                   - Barter's , Gitelman syndrome                                                                                                       - Salt wasting nephropathy                                                                                                               - RTA type 1 and 2(renal tubular acidosis) Vomiting,diarrhea                                      CLINICAL FEATURES: Cramps/weakness Flaccid paralysis Hypercapnia: co2 narcosis DIAGNOSIS: Serum potassium (best) TTKG - Trans tubular potassium gradient . i
Read more

BRONCHIECTASIS

Image
Bronchiectasis : Destruction / Dilatation of large airways - airways are filled with pus results in the features of bronchorrhea HISTOPATHOLOGICAL  EXAMINATION: CYLINDRICAL / TUBULAR - MOST COMMON subtype - Represents airways are dilated and thick walled which filled with pus by the dangerous organisms like pseudomonas. this organism later will form the biofilm in the lungs which results in antibiotic resistant. expansion of pus filled cavity will erode the blood vessels of lungs which results is massive hemoptysis and death of the patient. Cause of  death - Massive hemoptysis Causes : A) FOCAL - Obstruction which subsequently cause infection in the airway and results in pus. following condition can cause focal bronchiectasis - Foreign body aspiration (children) - Pulmonary hamartoma (adults) - Bronchial carcinoid (adults) note: Benign tumor in adults like pulmonary hamartoma and carcinoid tumors which encroached the bronchus and result in obstruction of airways and causes atelectasis.
Read more

COMMUNITY ACQUIRED PNEUMONIA

Image
Acute infection of pulmonary parenchyma Causative Organism : Streptococcus pneumoniae (pneumococci) - most common Haemophilus influenzae - 2nd most common Mycoplasma pneumonia Chlamydia pneumonia Rare : Legionella Staphylococcus aureus Gram negative organism ( klebsiella , pseudomonas) virus (adenovirus , meta pneumo virus) In India : - 20% cases of CAP - Tuberculosis - 40% cases of CAP - Not established PATHOLOGY : Initially there is a inhalational of bacteria into the lungs results in phase of Edema  ↓  proteinaceous exudates developed in the alveoli (so there can be a crepitation, crackles of  bronchial breathing in the patient and subsequently patients enter into the following phases) Red hepatization - RBC + Neutrophils (3-4 days) Grey hepatization - RBC lysis + Neutrophils (it signifies successful)(5 -7 days) Resolution - here Macrophages predominantly present because these cells restore the normal tissue Typical / lobar pneumonia : Lobar consolidation causative organism ; - Pneu
Read more