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06-05-2009, 09:28 AM
Group of G.N.
presented with nephrotic $

Minimal lesion (Nil $):
This is not a true glomerulonephritis due to absence of inflammation& inflammatory changes.
Common in children.
20 % of adult nephrotic $.
Steroid sensitive.
Selective proteinuria.
Renal failure usually does not occur.
Causes:
1 ry idiopathic.
2 ry NsAID - lymphoma.









Micro:
light almost normal (nil)
E / M fusion of foot process, of epith. Cells or
effacement.
Immunoflorescence - ve (nil) (no Ab or C)

C /P: Nephrotic $ see later.

ttt: (4-2-4)

* Prednisolone 60 mg / m2 orally for 4 wks or until proteinuria
disappears. ( normal body surface area 1.73 m2).

*When the urine has been free from proteins continue the
drug for 2 wks then prednisolone should be gradually
reduced over 4 wks.
*if relapse occurs on withdrawal of steroid remission is induced with steroid therapy once more & a course of
cyclophosphamide can be given


Cyclophosphamide may be used 2 mg / kg / d and continued for 2 wks after remission or withdrawn after 6 wks if no response.
Indicat. Steroid resistant.
Steroid dependent
Frequent relapses
Recently cyclosporine can be used also.

Prognosis:

There is remission and exacerbation
Relapses occurring many years later are recognized but even I in the long term there does not seem to be any deterioration of
renal function.

Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)