Nephrotic Syndrome

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