0 Nephrotic Syndrome

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Nephrotic Syndrome

• Proteinuria (Albuminuria) > 40 mg/l2/hr (or > 2g /day )
• Hypoproteinemia  < 2.5 g/dl
• Hyperlipidemia (Serum cholesterol  > 200 mg/dl)

=> 85 % cases are Minimal change disease.
Electron microscopy shows effacement of foot process of podocytes.

=> In Adults Most common is Membranous glomerulonephritis (can have Renal vein thrombosis)

=> Mostly nephrotic syndrome is steroid sensitive, thus DOC - Prednisolone.

Clinical features :

1. Oedema
2. Hypovolemia
3. Loss of Ig in urine - thus infections (Most common Spontaneous bacterial peritonitis - cause Pneumococcus ) (DOC - Cefotaxime)
4. Loss of Protein C and S (thus risk of thrombosis)

Most common cause of steroid resistant nephrotic - FSGS

 Genetics : 

• NPHS 1 - Nephrin ( Mutation causes FINNISH syndrome)
• NPHS 2 - Podocin ( Mutation causes steroid resistant nephrotic syndrome)

DOC for steroid resistant nephrotic : 

• Tacrolimus ( Its Calcineurin inhibitor )
• Other Calcineurin inhibitor is Cyclosporin - Side effect Acne , Gingival hyperplasia

Both are nephrotoxic.

• Rituximab (Monoclonal Antibody against CD 20)

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