Nephrotic Syndrome

With this condition, the glomerular basement membrane becomes very leaky to proteins.

The most common cause in children is Minimal Change Disease.

The most common cause in adults is Membranous Glomerulonephritis.

Other causes include:

• Intrinsic Kidney Disease - Focal segmental glomerulosclerosis, Membranoproliferative glomerulonephritis

• Systemic diseases – SLE, Henoch Schoenlein purpura (HSP), Diabetes

• Infections - HIV, Hepatitis, Malaria, Syphilis

• Drugs – NSAIDs, Heroin

Presentation

The main presenting features are:

• Frothy urine – Due to the Proteinuria

• Oedema – Periorbital typically first, followed by peripheral oedema, ascites and perineal oedema

• Hypoalbuminaemia

• Hyperlipidaemia

• Hypercoagulability - patients may end up have recurrent clots i.e venous or arterial thrombosis

• HTN

Hyperlipidaemia occurs here because the low albumin decreases the oncotic pressure, and in order to maintain a normal pressure, the liver compensates by increasing the synthesis of lipoproteins.

Investigations

• Urine dip – Proteinuria (> 3g/24hrs)

• Urinalysis – Raised ACR

• Renal biopsy

Management

The mainstay of treatment is High-dose steroids. Most respond really well within 4 weeks, after which they’re weaned off of it. If not responding well to the steroids, immunosuppressants can be given instead.

Other things that may be done:

• Low salt diet

• Diuretics if severely oedematous

• Albumin infusion in cases of severe Hypoalbuminaemia