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

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