Sindroma Nefrotik

Sindroma NefrotikNurul Iman

2011730079

Universitas Muhammadiyah Jakarta

Definisi

Kelainan ginjal Proteinuria

Hipoalbuminemia

Edema

+/- Hiperlipidemia

Systemic Disease

Intra Renal

Etiologi

PRIMARY SECONDARY

Minimal-change

nephropathy

Focal

glomeruloscleros

is

Membranous

nephropathy

Hereditary

nephropathy

Diabetes mellitus

SLE

Amyloidosis

Viral infection

Preeclampsia

Batasan

REMISI

RELAPS

SNSS

Relaps jarang

Relaps sering

SNRS

Dependen Steroid

Patomekanisme

- Soluble antigen- antibody complex

- Electrochemic theory

PATOMECHANISM NEPHROTIC SYNDROME

AutoimmuneGlomerulonephritis

Antigen

Soluble AG-AB

Complex

ELECTROCHEMIS THEORY

Epithel cell

GBM

Endothel cell

GBM:negative charge

SYMPTOMS & SIGNS

1. Oedema :

- Pitting oedema

- Generalized : starting in periorbital regions

face abdomen (ascites) extremities

- Pleural effusions

- Massive anasarca scrotal or vulval oedema

2. No hypertension or hematuria

3. Normal renal function

LAB RESULST

1. Proteinuria Masif (> 3.5 g / 24 hour)

2. Hypoalbuminemia (< 2.5 g / dL)

3. Hypercholestherolemia ( > 210 mg/dL)

4. Low Hematuri or not

MANAGEMENT

1. Hypoalbuminaemia (< 3 g/dL)

- Salt-poor human albumin (plasbumin) 1 gr/kgBW

2. Febrile / feels unwell / abdominal pain :

- Antibiotics

3. Diuretic : Indications : severe oedema that causes

dyspnoe

4. Specific treatment : corticosteroid

Protocol : International Study of Kidney Disease

in Children (ISKDC)

Medication

1. Corticosteroid

- Prednison, 2 mg/kgBW/day in 4 week, max : 80 mg/day, continue 1.5 mg/kgBW/day if remission is come. If remission is not come so is SNRS.

CD = 4 weeks

AD = 4 weeks Tap. off

Stop1 2 3 4 5 6 7 8

remission remission

PROTOCOL THERAPY OF RELAPS NS

CD

AD = 4 week Tap. off

Stop1 2 3 4

remission remission

2. Immunosupresan

- Cyclosporin, 1.5 – 2.5 mg/kg/12 hour

3. Diuretic

- Furosemide 0.5 – 1 mg/kgBW

- Spironolacton : - 0 – 10 kg : 6.25 mg/12 hour

- 11 – 20 kg : 12.5 mg/12 hour

- 21 – 40 kg : 25 mg/12 hour

- > 40 kg : 25 mg/8 hour

4. ACE Inhibitor

- Captopril, 0.1 mg/kg/8 hour oral

5. VipAlbumin (150 mg)

- 3 x 2 cap/day