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Disease NEPHROTIC SYNDROME
   
Quotation “Experience is a wonderful thing. It enable you to recognize a mistake when you make it again”
   
Definition A syndrome comprising of Glomerular proteinuria (>3.5 gm/day), Hypo-albuminaemia (serum albumin <3.0 gm/dl), oedema (peripheral or anasarca with ascites), Hypercholesterolaemia (fasting >200 mg/dl), and foamy urine with proteinuria, RBC, fatty and granular casts.
   
Prognosis Depends upon the cause. There is complete remission if basic disease is treatable (infection, drug induced). In general minimal change cases crespond to steroid therapy. In focal nad segmental glomerulosclerosis, on ly 30-40% respond to steroids, and most progress to end stage disease. Membranour glomerulosclerosis may respond with a remission on high doses of steroids with or without additional cytotoxic agents. The majority of membranous glomerulosclerosis progress to end-stage renal disease desDepends upon the cause. There is complete remission if basic disease is treatable (infection, drug induced). In general minimal change cases crespond to steroid therapy. In focal nad segmental glomerulosclerosis, on ly 30-40% respond to steroids, and most progress to end stage disease. Membranour glomerulosclerosis may respond with a remission on high doses of steroids with or without additional cytotoxic agents. The majority of membranous glomerulosclerosis progress to end-stage renal disease despite steroid therapyp. pite steroid therapyp.
   
Treatment

Generallised Edema, Puffy face, Albuminurea in a child.

 

High Protein diet.

Salt and fluid restriction only if gross edema,

Tab. Norflox 400mg. bd x 5 if urinary infection.

Tab. LASIX ½ to 1 OD till edema subsides with

Syp. Potchlor tst tds.

Steroid therapy.

Tab. Wysolene 5mg x 2-3 tds (2mg/ kg / day Prednisolon)

Till urine albumin is controlled i.e 4 to 8 weeks.

Then taper off gradually.

 

If Recurrence:

Repeat steroid course.

Refer to pediatrician for cyclophosphamide treatment.

Tab. Endoxan 2mg/kg x 3-4 weeks under regular blood count studies.

 

Drugs to avoid in Renal Damage.

 

Amiglycosides – Gentamycin, Streptomycin, Kanamycin

Terramycin, Ampicilin.

AKT-Rifampicin, Pyrazinamide.

Aspirin, Frusemide, ACE inhibitors like Enalapril.

Phenyton, Lithium, Acyclovir

 

Tab. Norflox

Syp. Potchlor

 

LASIX WYSOLONE 
   
General Measures Bed rest as tolerated. Salt restriction (40 mmols/day)High protein intake (1.5-2.0 gm/kg/day) if protein loss exceeds 10gms/day.Low fat,liberal potassium ubless hyperkalemicFluid restriction for hyponatraemia.Avoid nephrotoxicdrugs.
   
Advice to Patient Dietary, as instructed. Rigorous for monitoring azotemia, oedema, weight, BP, lipid levels, and use of nephrotoxic drugs.
   
Inadequate Response Might call for renal biopsy for a firm diagnosis, or might need addition of cyclophophamide for the steroid resistant case. The decision for a renal biopsy is best left with the nephrologist
   
Prevention Avoid causative factors wherever possible.
   
Reference From www.nephrologychannel.com/nephrotic/diagnosis.shtml
   

 
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