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NEPHROTIC SYNDROME
- A PRESENTATION BY NAYEEM AHMED
What is Nephrotic Syndrome ?
NEPHROTIC SYNDROME IS A NONSPECIFIC KIDNEY DISORDER CHARACTERISED BY A NUMBER OF SIGNS OF DISEASE: PROTEINURIA, HYPOALBUMINEMIA AND EDEMA.
NEPHROTIC SYNDROME (NS) RESULTS FROM INCREASED PERMEABILITY OF GLOMERULAR BASEMENT MEMBRANE (GBM) TO PLASMA PROTEIN.
Nephrotic Syndrome (Nephrosis)
The Main Trigger Of primary Nephrotic Syndrome and Fundamental and highly
important change of pathophysiology :-
Proteinuria
In Short
It is clinical and laboratory syndrome characterized by massive proteinuria, which lead to hypoproteinemia (hypo-albuminemia), hyperlipidemia and pitting edema.
NS in a nutshell• Proteinuria
• Protenima (Hypoalbuminemia)
• Hyperlipidemia
• Generalized edema (Anasarca)
• Oliguria
• Hypertension
Causes Amyloidosis : A group of diseases resulting from abnormal deposition of certain proteins (amyloids) in various bodily areas.
Membranous Glomerulopathy: Is a kidney disorder that leads to changes and inflammation of the structures inside the kidney that help filter wastes and fluids.
Diabetes Foot Process Disease:In minimal change disease, there is damage to the glomeruli
ClassificationPrimary Idiopathic NS (INS): majority The cause is still unclear up to now. Recent 10 years
evidence has suggested that INS may result from a primary disorder of T– cell function.
Accounting for 90% of NS in child.
Secondary NS: Congenital NS: rare 1st 3 month of life, only treatment renal transplantation.
Secondary NS Drug Toxicity Allergy Infection: HBV, HIV, leprosy, syphilis, Schistosomiasis. Autoimmune or collagen-vascular diseases Metabolic disease: Diabetes mellitus.
Neoplasma: Hodgkin’s disease, carcinoma. Genetic Disease: Sickle cell disease, Amyloidosis, Congenital nephropathy.
Idiopathic NS (INS)• Minimal Change Nephropathy (MCN): <80%
• Non—Minimal Change Nephropathy:< 20%
Some FactsNephrotic syndrome is 15 times more common in children than in Nephrotic syndrome is 15 times more common in children than in adults. adults.
Most cases of primary nephrotic syndrome are in children and are Most cases of primary nephrotic syndrome are in children and are due to minimal-changedue to minimal-change disease. disease.
Nephrotic criteria*Massive proteinuria : qualitative proteinuria: 3+ or 4+, quantitative proteinuria : more than 3.5gms/day in children (selective).
*Hypo-proteinemia : total plasma proteins < 5.5g/dl and serum albumin : < 2.5g/dl.
*Hyperlipidemia : serum cholesterol : > 5.7mmol/L
*Edema : pitting edema in different degree
Pathophysiology
Glomerular Damage Proteinuria Hypoproteinemia Edema Hyperlipidemia
Proteinuria
Reduced Albumin
Reduced oncotic pressure
Edema
Reduced blood volume
Activation of RAAS
Edema
Sequelae. because of NS
Hyperlipidemia; Pathogenesis of:Response to Hypoproteinemia → reflex to liver --→ synthesis of generalize protein ( including lipoprotein ) and lipid in the liver ,the lipoprotein high molecular weight no loss in urine → hyperlipidemia
*Diminished catabolism of lipoprotein
Clinical Manifestations1.Main manifestations: Edema (varying degrees) is the common symptom
Local edema: edema in face , around eyes( Periorbital swelling) , in lower extremities. Generalized edema (anasarca), edema in penis and scrotum.
2.Non-specific symptoms:Fatigue and lethargyloss of appetite nausea and vomiting abdominal pain diarrheabody weight increase urine output decrease pleural effusion (respiratory distress)
Examples of Clinical MenifestationsPeriorbital swellingAnasarca
Management of Nephrotic Syndrome
General (non specific)
*Corticosteroid therapy
General (non-specific)HospitalizationDiet : Hypertension and edema: Low salt diet. Severe edema: Restricting fluid intake Avoiding infectionDiuresisVaccination
Corticosteroid- Prednisone therapy:
Prednisone is a corticosteroid. It reduces swelling. It is used for many conditions among them: Allergic reactions Skin diseases Breathing problems Certain Cancers Blood disorders Eye problems Hormone replacement
Thank you for you Patience and concentration