Nephrotic $
It is a syndrome Ch.Ch. by heavy proteinuria > 3.5 gm /24 hrs / 1.73m2 with hypoproteinemia & edema.
Usually hypercholesterolemia & lipiduria are present.

Causes

Primary G.N. minimal Lesion.
Membranous G.N.
FSGS
membroproliferative,
Mesangioproliferative

Secondary Diabetic nephropathy
( Kimmelsteil wilson $).
Collagen D SLE.
Amyloidosis.
B - malaria.
Drugs.


C/P
Edema Starts as puffiness then LL edema.
Serous membranous trasudation e.g. pleural
effusion
Gradual onset. Ascites
Pericardial effusion
No hypert. Or oligurea or azotemia except late in some
Types.
Manifest. Of the cause as S.L.E.
1- Pt with nephrotic $ + dyspnea.

Pl. effusion p. effusion pulm E pneumonia

stoney dull inspiratory chest pain FAHM
filling of neck v.
2-Pts with nephrotic $ liable to pneumonia due to loss of Ig in urine& cytotoxic drugs & steroids immunodeficiency
& cytotoxic drugs & steroids immunodeficiency
3-Proteins lost in urine
Albumin. d) Protein C, S.
Immuno glob. e) Anti thrombin.
Thyroglobulin. f) Transferrine.
4-Protein C & S are - circulating anticoagulants
So loss of them pt liable to DVT pulm. E

D.D of nephrotic $
| Other causes of Generalized edema
| G.N presented by nephrotic $.
Investig.

S. Cr., S. urea, S. BUN normal.
Except late in some G.N.
­­
3-S. albumin ¯¯
4-Urine
­­ prot. > 3.5gm/24h urine.
cast (hyaline or
fatty cast.)
5-Biopsy (diag. - prognosis - response to ttt).
Light - E/M - immunoflurecence
ttt
Diet & nutrition:

If kid function impaired If kid function normal

give salt free albumin normal protein intake is
but it is expensive and will be advisable because
­­ proteins in lost in urine so, it gives diet ­­ glomerulosclerosis
transiet effect

Diuretics Lasix- aldactone for 2ry hyperaldosteronism
Specific ttt (see before) according to the type of G.N.

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