Introduction
Nephrotic Syndrome is a clinical complex characterized by:
- Proteinuria of 3.5 g per 24 hours
- Hypoalbuminaemia
- Generalized oedema
- Hyperlipidaemia;
- lipiduria
- Hypercoagulability
Aetiology
- It is idiopathic in a significant proportion of cases
Its known causes include:
- Inflammatory diseases of the glomeruli (glomerulopathies)
- Viral infections e.g. Hepatitis B, HIV
- Immunologic disorders e.g. SLE
- Allergies: insect bites, poisonous plants
- Intravenous drugs e.g. heroin
- Others:
- Diabetes mellitus
- Carcinomas
- Amyloid deposition
Histologic types
- Minimal change disease
- Focal segmental glomerulosclerosis
- Membranous glomerulopathy
- Mebrano-proliferative glomerulonephritis
- Mesangio-proliferative glomerulonephritis
Clinical features
- Generalized body swelling
- Passage of frothy urine
Complications
- Peripheral arterial or venous thrombosis
- Acceleration of atherosclerosis
- Protein malnutrition
- Vitamin D deficiency
- Increased susceptibility to infections
- Iron-resistant microcytic hypochromic anaemia
Differential diagnoses
- Other causes of body swelling
- Congestive heart failure.
- Decompensated chronic liver disease.
- Protein losing enteropathy
Investigations
Blood:
- Serum proteins
- Serum lipids Urine:
- Urinalysis
- 24 hour urine collection for protein estimation
- Abdominal ultrasound scan
- Renal biopsy
Treatment objectives
- Reduce proteinuria
- Eradicate peripheral oedema
Drug treatment
- Diuretics e.g. loop diuretics like furosemide
- Glucocorticoids (e.g. prednisolone)
- If renal biopsy and histology reveal a steroid-responsive cause of the nephrotic syndrome
- Cytotoxic drugs (e.g. cyclophosphamide) in some steroid resistant cases
Prevention
- Avoid nephrotoxins
- Treat bites and stings to prevent p. haemolytic streptococcal infection