Nephrotic syndrome: Difference between revisions
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==Disposition== | ==Disposition== | ||
Admit: | Admit: | ||
*Severe | *Severe edema | ||
*Pulmonary effusion or respiratory symptoms | *Pulmonary effusion or respiratory symptoms | ||
*Infection or thrombotic complications | *Infection or thrombotic complications |
Revision as of 10:54, 3 May 2014
Background
- Increased permeability of glomerular capillary wall
- Proteinuria, hypoproteinemia (alb <3), edema, hyperlipidemia
- Life-threatening complications are infection and thromboembolic events
Diagnosis
- Edema (face, periphery)
- SOB, cough (pleural effusion, pulmonary edema)
- Oliguria
Work-Up
- UA
- Proteinuria, no hematuria
- CBC
- Chemistry
- Pseudohyponatremia due to elevated triglycerides
- Lipid panel
- ANA, C3, C4, Hep panel
- CXR (only if suspect pleural effusion / pulm edema)
- Ultrasound
- Only if suspect renal vein thrombosis - hematuria, flank pain, ARF
DDx
- Primary nephrotic syndrome
- Minimal-change, Membranoproliferative
- Secondary nephrotic syndrome
- SLE, HSP, SCD
Treatment
- Give IV fluids if e/o hypovolemic shock (even if edema is severe)
- Volume overload
- Treat w/ 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 x6wk
- Low-salt diet
Disposition
Admit:
- Severe edema
- Pulmonary effusion or respiratory symptoms
- Infection or thrombotic complications
Outpt nephrology f/u:
- Mild-moderate edema
Source
Tintinalli