NEPHROTIC

SYNDROME

DHALAYAN PRAKASHRAJ
18-0874-261

MARCH BATCH
NOV 21 – DEC 4
 The nephrotic syndrome is a primary glomerular disease
characterized by

 1.High levels of protein (albumin) in the urine (proteinuria).

 2. Low leves of proteins in the blood ( hypoalbuminemia).
 3.Increased levels of lipid (hyperlipidemia).
 4.Swelling of body parts (edema).
 CLASSIFICATION

Congenital Idiopathic Secondary

nephrotic or primary nephrotic
syndrome nephrotic syndrome
syndrome
CONGENITAL NEPHROTIC SYNDROME

❑It is rare but serious and fatal problem usually associated with
other congenital abnormalities of kidney ( Polycystic kidney, Horse
shoe shaped).
❑It is inherited as autosomal recessive disease
❑Severe renal insufficiency and urinary infections along with this
condition result is poor prognosis
IDIOPATHIC OR PRIMARY NEPHROTIC SYNDROME

❑ It is the most commom type (about 90%) and regarded as

autoimmune phenomenon as it responds to immunosuppressive
therapy.
❑Subgroups of this type
• Minimal change nephrotic syndrome (85%)
• Proliferative nephrotic syndromes (5%)
• Focal sclerosis nephrotic syndrome (10%)
SECONDARY NEPHROTIC SYNDROME

❑It occurs in children about 10% of al cases.

❑This condition occur due to some form of
✔Chronic glomerular nephritis
✔Diabetes mellitus
✔Systemic lupus erythematosus (SLE)
✔Malaria
✔Malignant hypertension
✔Hepatitis ‘B’
✔Infective endocarditis
✔Drug toxicity, lymphomas
✔Syphilis
CAUSES & RISK FACTORS
Nephrotic syndrome is usually caused by damage to the clusters of tiny blood vessels (glomeruli) of the kidneys.
CAUSES & RISK FACTORS
Nephrotic syndrome is usually caused by damage to the clusters of tiny blood vessels (glomeruli) of the kidneys.

CAUSES & RISK FACTORS

❖ Focalsegmental glomerulosclerosis :
Characterized by scattered scarring of the glomeruli, this condition may result
from another disease or a genetic defect or occur for no known reason.

❖Minimal change disease :

This is the most common cause of nephrotic syndrome in children. Minimal
change disease results in abnormal kidney functions, but when the kidney
tissue is examined under a microscope , it appears normal or nearly normal
 CAUSES & RISK FACTORS

❖ Membranous nephropathy :
This kidney disorder is the result of thickening membranes within the glomeruli.
The cause of thickening is unknown, but sometimes it is associated with medial
conditions such as hepatitis B, Malaria, Lupus and Cancer
❖ Systemic lupus erythematosus :
This chronic inflammatory disease can lead to serious kidney damage
❖Amyloidosis :
This disorder occurs when substances called amyloid proteins accumulate in
organs. Amyloid buildup often affects the kidneys, damaging their filtering system.
 CAUSES & RISK FACTORS

❖ Renal vein thrombosis :

Occurs when a blood clot blocks a vein connected to the
kidney, can cause nephrotic syndrome.
 RISK FACTORS

Certain diseases and conditions increase risk of developing

nephrotic syndrome such as diabetes, lupus, amyloidosis and
other kidney diseases.
Medications that cause nephrotic syndrome include non
steroidal anti-inflammatory drugs and drugs used to fight
infections
Infections that increase the risk of nephrotic syndrome include
HIV, Hepatitis B, He.patitis C and Malaria
PATHOPHYSIOLOGY
 CLINICAL MANIFESTATIONS

Proteinuria
Hypoalbuminemia
Hyperlipidemia
Periorbital edema
Ascites
Respiratory difficulty
Anorexia
Anasarca
 CLINICAL MANIFESTATIONS

Pallor and shiny skin with prominent vein

Change in the quality of hair due to protein deficiency
Weight gain
Fatigue and lethargic
Hypertension or hypotension
Pitting edema
 LAB INVESTIGATIONS

Urine
• Urine culture
• Quantitative urinary protein excretion
• Urine UFEME

Blood
• Renal profile
• Serum cholesterol
• Liver function Tests – Particularly serum albumin

Others
• ANA
• Anti-dsDNA
• C3, C4
• ASOT
 DIAGNOSIS
 PALPATION:
 Due to edema and ascites kidney cannot be palpable
 URINE ANALYSIS:
 Hematuria
 24 hour urinary total protein estimation- urine sample shows
proteinuria (>3.5 g per litre 24 hours).

BLOOD TEST
 BUN
 S.Creatinine
 S.protein decreases
 Lipid profile shows high level of S.
cholesterol- 200mg.
 MANAGEMENT

 Presence of ARF and hypertension requires

hospitalization
✦ Diet
✦ Weight
✦ Fluid restrictions
✦ Antibiotics
✦ Diuretics
✦ Alkalinization of urine
THANK YOU