Diferencia entre revisiones de «Nephrotic syndrome»
Sin resumen de edición |
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==Background== | ==Background== | ||
*Increased permeability of glomerular capillary wall | *Increased permeability of glomerular capillary wall | ||
**Proteinuria, hypoproteinemia ( | **Proteinuria, [[hypoalbuminemia|hypoproteinemia]] (albumin <3), edema, hyperlipidemia | ||
*Life-threatening complications are infection and thromboembolic events | *Life-threatening complications are [[infection]] and [[thromboembolism|thromboembolic events]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Edema (face, periphery) | *Edema (face, periphery) | ||
*[[ | *[[Shortness of breath]], cough ([[pleural effusion]], [[pulmonary edema]]) | ||
*Oliguria | *Oliguria | ||
===Complications<ref>Park SJ and Shin JI. Complications of nephrotic syndrome. Korean J Pediatr. 2011 Aug; 54(8): 322–328.</ref>=== | |||
*Chronic high dose steroid adverse effects | |||
*[[Pulmonary embolism]] | |||
*[[Renal vein thrombosis]] | |||
*[[hypovolemia|Hypovolemic]] crisis | |||
*[[Acute kidney injury]] | |||
*[[Infection]] | |||
*Cardiovascular issues (hyperlipidemia) | |||
*[[Anemia]] | |||
*[[Hypocalcemia]] | |||
*[[Hypothyroidism]] | |||
*[[Intussusception]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Primary nephrotic syndrome | *Primary nephrotic syndrome | ||
**Minimal-change, | **Minimal-change, membranoproliferative | ||
*Secondary nephrotic syndrome | *Secondary nephrotic syndrome | ||
**[[SLE]], [[HSP]], [[SCD]] | **[[SLE]], [[HSP]], [[SCD]] | ||
*Classical characteristics/risk factors: | *Classical characteristics/risk factors: | ||
**Minimal change disease - children, preceded by [[URI]] | **Minimal change disease - children, preceded by [[URI]] | ||
**Focal segmental glomerulosclerosis - Black patients, [[HIV]]/IVDA | **Focal segmental glomerulosclerosis - Black patients, [[HIV]]/[[IVDA]] | ||
**Membranous nephropathy - White patients, HBV, HCV, SLE, gold, penicillamine, malignancy | **Membranous nephropathy - White patients, [[HBV]], [[HCV]], [[SLE]], gold, [[penicillamine]], malignancy | ||
**Type 1 MPGN - HBV, HCV | **Type 1 MPGN - [[HBV]], [[HCV]] | ||
**Type 2 MPGN - ↓ C3 | **Type 2 MPGN - ↓ C3 | ||
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**Serum albumin < 25 g/L | **Serum albumin < 25 g/L | ||
*Lipid panel, with total cholesterol > 380mg/dL (10 mmol/L) | *Lipid panel, with total cholesterol > 380mg/dL (10 mmol/L) | ||
*ANA, C3, C4, | *ANA, C3, C4, [[viral hepatitis]] panel | ||
*[[CXR]] (only if suspect pleural effusion / pulmonary edema) | *[[CXR]] (only if suspect pleural effusion / pulmonary edema) | ||
* | *[[Renal ultrasound]] | ||
**Only if suspect renal vein thrombosis - hematuria, flank pain, | **Only if suspect renal vein thrombosis - [[hematuria]], [[flank pain]], [[AKI]] | ||
==Management== | ==Management== | ||
*Give IV fluids if evidence of hypovolemic shock (even if edema is severe) | *Give [[IV fluids]] if evidence of [[hypovolemic]] [[shock]] (even if edema is severe) | ||
*Volume overload | *[[fluid overload|Volume overload]] | ||
**Treat with [[furosemide]] 1-2mg/kg | **Treat with [[furosemide]] 1-2mg/kg | ||
**May require correction of hypoalbuminemia first; 0.5-1gm/kg | **May require correction of hypoalbuminemia first; 0.5-1gm/kg | ||
*Steroids | *[[Steroids]] | ||
**Effective for minimal-change disease | **Effective for minimal-change disease | ||
**[[Prednisone]] 2mg/kg/d in 2-3 divided doses x 6 weeks | **[[Prednisone]] 2mg/kg/d in 2-3 divided doses x 6 weeks | ||
*Low-salt diet | *Low-salt diet | ||
*Prophylactic anticoagulation for thromboembolic events not recommended, unless patient had previous thrombotic events | *Prophylactic anticoagulation for thromboembolic events not recommended, unless patient had previous thrombotic events | ||
==Disposition== | ==Disposition== | ||
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[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Renal]] | |||
Revisión del 18:52 6 oct 2019
Background
- Increased permeability of glomerular capillary wall
- Proteinuria, hypoproteinemia (albumin <3), edema, hyperlipidemia
- Life-threatening complications are infection and thromboembolic events
Clinical Features
- Edema (face, periphery)
- Shortness of breath, cough (pleural effusion, pulmonary edema)
- Oliguria
Complications[1]
- Chronic high dose steroid adverse effects
- Pulmonary embolism
- Renal vein thrombosis
- Hypovolemic crisis
- Acute kidney injury
- Infection
- Cardiovascular issues (hyperlipidemia)
- Anemia
- Hypocalcemia
- Hypothyroidism
- Intussusception
Differential Diagnosis
- Primary nephrotic syndrome
- Minimal-change, membranoproliferative
- Secondary nephrotic syndrome
- Classical characteristics/risk factors:
Periorbital swelling
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- Ocular compartment syndrome
- Orbital tumor
No proptosis
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryocele/Dacryocystocele
- Dacryostenosis
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
Lid Complications
- Blepharitis (crusts)
- Chalazion (meibomian gland)
- Stye (hordeolum) (eyelash folicle)
Other
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Conjunctivitis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Sarcoidosis
- Granulomatosis with polyangiitis
Evaluation
- Urinalysis
- Proteinuria > 3.5 g/24 hr, no hematuria
- Spot urine protein : urine creatinine ratio of > 3 - 3.5mg/mg (300 - 350mg/mmol)
- CBC
- CMP
- Pseudohyponatremia due to elevated triglycerides
- Serum albumin < 25 g/L
- Lipid panel, with total cholesterol > 380mg/dL (10 mmol/L)
- ANA, C3, C4, viral hepatitis panel
- CXR (only if suspect pleural effusion / pulmonary edema)
- Renal ultrasound
- Only if suspect renal vein thrombosis - hematuria, flank pain, AKI
Management
- Give IV fluids if evidence of hypovolemic shock (even if edema is severe)
- Volume overload
- Treat with furosemide 1-2mg/kg
- May require correction of hypoalbuminemia first; 0.5-1gm/kg
- Steroids
- Effective for minimal-change disease
- Prednisone 2mg/kg/d in 2-3 divided doses x 6 weeks
- Low-salt diet
- Prophylactic anticoagulation for thromboembolic events not recommended, unless patient had previous thrombotic events
Disposition
Admit
- Severe edema
- Pulmonary effusion or respiratory symptoms
- Infection or thrombotic complications
Outpatient nephrology follow up
- Mild-moderate edema
References
- Kodner C. Nephrotic Syndrome in Adults: Diagnosis and Management. Am Fam Physician. 2009 Nov 15;80(10):1129-1134.
- ↑ Park SJ and Shin JI. Complications of nephrotic syndrome. Korean J Pediatr. 2011 Aug; 54(8): 322–328.