Nephrotic Syndrome

Nephrotic Syndrome

Is a clinical state characterized by an increased permeability of the glomerular membrane to protein, which results in massive urinary protein loss?

Nephrotic Syndrome

Aetiology:

the syndrome may be classified as :

1- Primary: idiopathic nephrotic syndrome.

2- Secondary: resulting from D.M, syphilis, AGN, or other conditions.

3- many observers think that nephrotic syndrome is an autoimmune disease.

Altered physiology:

For the unknown reason, the glomerular membrane usually impermeable to large proteins.

Protein especially albumin leaks through the membrane and lost in the urine.

Plasma proteins decrease as proteinuria increase.

The colloidal osmotic pressure reduced to result in oedema.

There is increased susceptibility to infection because of decreased gamma globulin.

The symptoms complex characterized by oedema, marked proteinuria, hypoalbuminemia and hypercholesterolemia.

Clinical manifestation:

Oedema, weight gain, puffiness of the face and abdominal swelling.

Respiratory difficulty ( pleural effusion).

Diarrhea, anorexia, malabsorption.

Extreme skin pallor, muscle wasting.

Irritability, easily fatigued, lethargic.

Decreased urinary output.

Normal or decreased blood pressure.

Susceptibility to infection.

Diagnostic evaluation:

1- urinalysis: oliguria, proteinuria.

2- kidney function test, usually normal.

3- blood:
Reduced total serum protein. normal ( 6.5 -8 g/dl).
Reduced serum albumin . normal ( 3.5-4.5g/dl ).
High serum cholesterol . normal ( 180-250 mg/dl ).

Management:

1- Rest: should be kept in bed during periods of severe oedema.

2- Prevention and treatment of infection.

3- Diet
- Appropriate for child age.

- Ample intake of proteins.

Increase the intake of calcium and vitamin D.

Restriction of fluid intake if oedema is progressive.

4 - Drugs:

Diuretics.

Prednisone.

Human albumin.



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