Acute Nephrotic Syndrome

Clinical Description

This condition is associated with proteinuria in excess of 3-3.5 g/1.73 m2 daily accompanied by hypoalbuminemia, oedema, hyperlipidemia and hypercoagulable state. Most often caused as a complication of a streptococcal infection. Usually manifests itself 1 – 5 weeks after an episode of pharyngitis, impetigo or infected scabies

Signs and Symptoms

• Oedema, low albumin, ascites, periorbital oedema, pleural effusion, genital oedema, protein energy malnutrition (especially in children)

Investigations

• Urinalysis, Urine microscopy (look for casts and check for Schistosoma ova), MPs and PCV, Electrolytes, Urea and Creatinine, Imaging on individual basis: renal USS, CXR, cardiacEcho

Non-pharmacological

• Monitor BP, urine output, weight
• Avoid added salt
• Treatment is usually supportive

Pharmacological

Adult

For control of oedema:

• Give Frusemide 40-80 mg 24 hourly (may require intravenous frusemide)

If hypertension is present:

• Treat accordingly (hypertension treatment section)

For control of proteinuria:

Use Angiotensin Converting enzyme inhibitors (i.e. Enalapril)

Note: Renal diseases can easily be mistaken for malnutrition