NEPHROTIC SYNDROME

 

1. Definition

Nephrotic syndrome is a clinical syndrome of massive proteinuria defined by

- Oedema

- Hypoalbuminaemia of < 25g/l

- Proteinuria > 40 mg/m²/hour 

(> 1g/m²/day) or  an early morning urine protein creatinine index of >200 mg/mmol (> 3.5 mg/mg)

- Hypercholesterolaemia

2. Cause

- Primary or Idiopathic (unknown cause) - commonest type in children

- Secondary 

✅ Infection : streptococcal

✅ Systemic condition : SLE

✅ Malignancy : Leukaemia

✅ Hematological

3. investigation

- Albumin < 3g/dl

- Cholesterol > 250mg/dl

- FBC usually normal, raised ESR

- CXR to R/O pleural effusion

- Urinalysis

- Proteinuria +3 or +4

- Urinary protein excretion (>40mg/m2/hour)

- 24 hours urinary protein : creatinine ratio > 3

- Microscopic hematuria in 10%

- Pus cells in underlying UTI

 

4. Management

-  Advice for ambulate - prevent thrombosis, pulmonary embolism

- Prophylaxis oral penicillin ( penicillin 150 or 250 mg BD)

 

5.  Others 

1. Hypovolaemia

- p/w abdominal pain, cold periphery, poor pulse volume, hypotensive 

- Resucitation with IV human albumin 5% (volume expander)

- Bagi albumin just for reduce gross edema and resuscitation, jangan bagi just because blood albumin level low. If minimal edema or ascitis, can just give IV Lasix.

 

2.  Diuretic
- Not give if patient steroid sensitive, usually can give in ward because can monitor any hypovolemia, steroid resistant can give.

 

3.  Both came with EDEMATOUS
Must differentiate whether patient underfilled (hypovolume) or overfill (overload). If hypovolumic - give  IV albumin, not IV Lasix. Patient can develop more hypovolume.

 

 

2. STEROID IN NEPHROTIC SYNDROME

(Belum sempat study lagi pasal management ni. Draf2 dulu ya?)

- PREDNISOLONE

Initial diagnosis- 60mg/m2/ day (max 80mg/day)

For 4 weeks – NOT RESPOSE? - Renal Biopsy

- If RESPONSE? – Prednisolone 40 mg/m2 EOD for  4 weeks, then reduce 25% monthy over 4 months

Treatment relapse

• T Prednisolone  60mg/m2/ day till remission

• Then 40mg/m2/ EOD for 4 weeks then stop