DEFINITION- Nephritic Syndrome is a primary glomerular disease charactrised by, protenuria hypoalbumineia, oedema, & hyperlipidemia.
ETIOLOGY-
1 Primary glomerular disease – Glomerulo Nephritis
2 Multisystem Diseases – Diabetes Mellitus
3 Drug Cause – NSAID, Penicillamine,
4 Infections
5 Neoplasms
6 Allergic
PATHOPHYSIOLOGY –
Damage of glomerular capillary membrane
Loss of protein (albumin)
Hypoalbumineia
Decrease oncotic pressure
Generalize oedema (anasarca)
Activation of rennin angiotensin system
Sodium retention
Oedema
SIGN & SYMPTOMS –
• Ascites
• Head ache
• Fatigue
• Malaises
• Oedema in eye, brain, kidney
Diagnosis
Urinalysis will be able to detect high levels of proteins and occasionally microscopic haematuria.
Specifically elevated LDL, usually with concomitantly elevated VLDL, is indicative of nephrotic syndrome.
A kidney biopsy may also be used as a more specific and invasive test method. A study of a sample’s anatomical pathology may then allow the identification of the type of glomerulonephritis involved however; this procedure is usually reserved for adults as the majority of children suffer from minimum change disease that has a remission rate of 95% with corticosteroids. A biopsy is usually only indicated for children that are corticosteroid resistant as the majority suffers from focal and segmental glomeruloesclerosis.
Further investigations are indicated if the cause is not clear including analysis of auto-immune markers (ANA, ASOT, C3, cryoglobulins, serum electrophoresis), or ultrasound of the whole abdomen.
MANAGEMENT– The treatment of nephrotic syndrome can be symptomatic or can directly address the injuries caused to the kidney.
Symptomatic
The objective of this treatment is to treat the imbalances brought about by the illness: edema, hypoalbuminemia, hyperlipemia, hypercoagulability and infectious complications.
1. Edema: a return to an unswollen state is the prime objective of this treatment of nephrotic syndrome. It is carried out through the combination of a number of recommendations:
2. Rest: depending on the seriousness of the edema and taking into account the risk of thrombosis caused by prolonged bed rest.
3. Medical nutrition therapy: based on a diet with the correct energy intake and balance of proteins that will be used in synthesis processes and not as a source of calories.
4.Medication: The pharmacological treatment of edema is based on the prescription of diuretic drugs (especially loop diuretics, such as furosemide). In severe cases of edema (or in cases with physiological repercussions, such as scrotal, prenuptial or urethral edema) or in patients with one of a number of severe infections (such as sepsis or pleural effusion), the diuretics can be administered intravenously. This occurs where the risk from plasmatic expansion is considered greater than the risk of severe hypovolemia, which can be caused by the strong diuretic action of intravenous treatment
