Definition
Nephrotic syndrome is a clinical syndrome characterized by heavy protenuria, hypo albuminemia, oedema, and hyper cholesteronemia.
Clinical features
- Facial oedema
- Pedal oedema
- Anasarca,
- Anuria/oliguria
- Frothy urine
- Hypertension in10% of cases
Complications
- Congestive cardiac failure, Pulmonary oedema
- Spontaneous bacteria peritonitis,
- Renal vein thrombosis
- Acute kidney injury,
Myocardial infarction.
Investigations
- Urinalysis, 24hour urinary protein, serum protein (total and albumin), serum lipids, serum electrolytes, urea, creatinine, renal biopsy (when indicated)
Treatment
Objectives:
- To reduce oedema
- To reduce proteinuria
- To correct lipedemia
Drug Treatment
- Steroid at a dose of 60mg/m2/day single dose for 6-8weeks
- Reduce to 40mg/m2 alternate days for 4 weeks and thereafter gradually taper off
Note that steroid is not indicated in ALL categories of nephrotic syndrome
- Diuretics: slow acting like thiazides at a dose of 1-2mg/day in divided doses
- Slow K at 1-2mg/kg/day
- Transfusion with 25% salt poor albumin/plasma at a dose of 10ml/kg
- Low salt diet, high protein
- Immunization with Pneumococcal conjugate vaccine