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NEPHROTIC SYNDROME

Clinical presentation of glomerular diseas


I.

Acute glomerulonephritis

II.

Rapidly progressive glomerulonephritis

III. Chronic glomerulonephritis

IV. Persistent urinary abnormalities with few or no symp


V.

Nephrotic syndrome

Nephrotic syndrome

Clinical entity having miltiple causes and characterize


by increased glomerular permeability manifested
by massive proteinuria and lipiduria.
Massive proteinuria > 3.5 g/day
Edema anasarka
Hipoalbuminemia < 3.5 g/dl
Hiperkolesterolemia

Clinical manifestation of nephrotic syndro


Oedema
Hypertension
Dyslipidemia
Hypercoagulable state
Hypoproteinemia / proteinuria
Progressive renal failure
Trace metal deficiencies
Endocrine disturbances
Infectious / immunodeficiency states

Pathophysiology of the Nephrotic Syndrome

sification of the disease states associated with the development


nephrotic syndrome
I.

Primary Glomerulonepfritis
1. GN lesi minimal (GNLM)
2. Glomerulosklerosis fokal (GSF)
3. GN membranosa (GNMN)
4. GN membranoproliferatif (GNMP)
5. GN proliferatif lain

II. Secondary glomerulonephritis


1. Medications and toxin: obat antiinflamasi non-steroid, preparat
emas, penisilinamin, probenesid, air raksa, captopril, heroin
2. Allergens
3. Infection ( bacterial, viral, protozoal, helminthic )
4. Neoplasmic ( solid tumors, leukemia and lymphoma )
5. Systemic disease: Lupus eritematosus sistemik, artritis
reumatoid
6. Heredofamilial and metabolic disease

iagnostic approach in nephrotic syndrom


I. Clinical
II. Laboratory studies
III. Renal biopsy

I. Clinical
History
Preexisting disease
Previous infection
Drug ingestion
Arthritis, rash
Current pregnancy
Family history of renal disease
Physical examination
Severe obesity
Rash, arthritis
Diabetic retinopathy
Hypertension
Evidence of malignancy
Lipodystrophy
Lymphadenopathy/hepatosplenomegaly

II. Laboratory Studies


Urinalysis, sedimen urine, profil lipid

III. Renal biopsy

Minimal change disease


Focal segmental glomerulosclerosis
Membranous nephropathy
Membranoproliferative glomerulonephritis
Other glomerulonephritis

Suggested approach for initial treatment


( Minimal change disease )
Children

Prednisone 60 mg/m2/day until remission, then 40 mg/m2/48 h for


12 weeks, then reduce by 5-10 mg/m2/48 h every month.

Adults

Prednisone 1mg/kg/day until remission or for 6 weeks, then 1.6 mg/kg/


for 1 month, then reduce by 0.2-0.4 mg/kg/48 h.

Elderly

Prednisone 1 mg/kg/day until remission or for 4 weeks, then 0.8 mg/kg


for 2 weeks, then 1.6 mg/kg/48 h for 2 weeks. Then reduce by 0.4 mg/
every 2 weeks. If no remission continue with 1.2 mg/kg/48 h for anothe
4 weeks then reduce.

Contraindications to prednisone

Cyclophosphamide 2 mg/kg/day or chlorambucil 0.15mg/kg/day for 8-1


weeks

THANK
YOU

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