Nephrotic Syndrome

• definition: clinical syndrome of massive proteinuria defined by
  • oedema
  • hypoalbuminaemia
  • proteinuria
  • hypercholesterolaemia

signs and symptoms

• Hypoalbuminaemia <25 g/l
• Protienuria > 40 mg/m2/hour
• Oedema
• Hypercholeterolaemia
• Pitting edema (95%) : Lower extremities, face, periorbital region, scrotum / labia, ascites , sudden weight gain -> Anasarca

• hypovolaemia:
  • abdominal pain
  • cold periphery
  • poor capillary refilling
  • poor pulse volume
  • low blood pressure
• tx: Infuse Human Albumin 0.5 – 1 g/kg/dose fast. do not give frusemide.

• Hypervolemia
  • basal lung crepitations
  • rhonchi
  • hepatomegaly
  • hypertension

Etiology

• Primary : idiopathic – common
• Secondary: Post strep, SLE

Investigation

• weight monitoring
• strict i/o chart
• FBC – TWC raised
• Renal profile : Urea, Electrolyte, Creatinine
• Serum cholesterol
• Liver Function – albumin
• Urine protein: creatinine ratio / 24 hour urine protein
• Antinuclear factor / anti-dsDNA
• Serum complement (C3, C4) – exclude SLE, post infectious
• ASOT titre – to exclude post strep
• renal biopsy – steroid resistant nephrotic syndrome

Treatment

• start oral prednisolone
  • initially give 60mg/m2/day for 4 weeks (max 60mg)
  • then, alternate day 4o mg/m2/day for 4 weeks (max 40 mg/day)
  • then, taper over 4 weeks and stop

remission: urine dipstix trace/nil for 3 consecutive days

• relapse: urine albumin excreation >40 mg/m2/hour or urine dipstix of =/> 2+ for 3 consecutive days.