NEPHROTIC SYNDROME
NEPHROTIC SYNDROMETutor:Prof. dr. Taralan Tambunan, Sp.A (K)Presented by:Ilham Saputra (06-005)1DISCUSSION TOPICSIntroductionDefinitionClassification And CausesPathophysiologyClinical Features
Laboratory FindingsPathological FindingsHow To DiagnosisTreatmentComplicationPrognosis
2INTRODUCTIONNS is a serious medical condition characterized by swelling, protein in the urine, decreased protein in the blood and high cholesterol levels. It can occur at any age. The reason NS must be treatedInfection. Risk of blood clots. 3DEFINITIONA nonspecific disorder in which thekidneys are damaged, causing them to leak large amounts ofprotein from theblood into the urine.4CLASSIFICATION AND CAUSESBased on etiology:PrimarySecondary
Based on histologicMCD (Minimal Changes Disease)FSGS (Focal Segmental Glomerulosclerosis)MN (Membranous Nephropathy)MPGN (Membranoproliferative Glomerulonephritis)
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7HOW TO DIAGNOSISThe gold standard in diagnosis of nephrotic syndrome is 24-hour urine protein measurement. Aiding in diagnosis are blood tests and sometimes imaging of the kidneys (for structure and presence of 2 kidneys), and/or a biopsy of the kidneys.
8TREATMENTDiet: sodium restrictedA normal activity is recommendedConsultation with a pediatric nephrologistCorticosteroid: Prednisone 1,5 mg/KgDiuretic: Furosemid 1-2 mg/Kg/dAntihypertension: ARB Zinc 10 mg/dSurgical Care: Peritonitis
9COMPLICATIONInfection: VaricellaThrombosisHyperlipidemiaAcute kidney failure10PROGNOSISDepends on the cause of nephrotic syndrome. It is usually good in children, becauseminimal change diseaseresponds very well tosteroidsand does not causechronic renal failuire. However other causes such asfocal segmental glomerulosceloris frequently lead toend stage renal disease. Factors associated with a poorer prognosis in these cases include level ofproteinuria,blood pressure control and kidney function (GFR).11REFERENCESTimothy E. Bunchman, MD. http://www.aakp.org/aakp-library/nephrotic-syndrome/. Taken 30th July 2010nephrotic syndromeatDorland's Medical DictionaryLane Jerome C. Nephrotic Syndrome in Pediatric. Available from: URL: http://emedicine.medscape.com/article/982920-overview. Accesed on 30th July 2010. http://en.wikipedia.org/wiki/Nephrotic_syndromePatel Parul. Nephrotic Syndrome. Available from: URL: http://www.nlm.nih.gov/medlineplus/ency/article/000490.htm. Accesed on 30th July 2010Bergstein Jerry M. Nephrotic Syndrome in Nephrology. E-book Nelson Textbook of Pediatrics. 18th Ed. Philadelphia: 2008. Chapter 527.
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