Post on 04-Jun-2018
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AGN NEPHROTIC SYNDROMEMost common Acute poststreptococcal GN (APSGN) Minimal change disease (MCD)Cp 1. Subclinical course (asymptomatic)
C3 Hematuria Proteinuria Normal/ BP
2. Nephritic syndrome Dark colored urine (hematuria) Edema HTN Oliguria Mild/moderate proteinuria Renal impairement
3. Complications Acute renal failure (25%) Hyperkalemia Rapid progressive azotemia
8/13/2019 AGN and NS
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4. Edema : salt restriction & macrolides5. HTN: CCB, ACEIs, VDs6. Hyperkalemia: restrict K7. Immediate dialysis
Severe hyperkalemia Azotemia
Acidosis Uncontrolled HTN CVS insufficiency Pulmonary edema
Furosemide 1-2mg/kg, Spironolactone5-10mg/kg
Severe edema: furosemide + albumin20% (1g/kg)
Refractory edema: drainage of ascitesand/or pleural effusion
4. Thromboemboli: warfarin, low doseaspirin, dipyridamole
5. Infections: Strep.pneumonae: oral penicillin,
pneumococcal vaccine Varicella: varicella immunity status,
acyclovir, varicella vaccination6. Hyperlipidemia: lowering regimen7. Oral steroid (specific therapy)
Prednisone/Prednisolone 60mg/m 2/d(max), 20mg/kg/d for 4 months
8. TTT of relapse: steroid sparing agent
Cyclophosphamide Cyclosporine9. TTT of Steroid Resistant NS (SRNS)
ACEIs & ARB immunosuppresive
Prognosis -complete recovery >95%-recurrence: very rare
-SSNS : excellent-SRNS & MCD: later remission-about 50% of SRNS due to FSGS reach endstage renal disease in 7-10y
Generalized edema:
Nephrotic Syndrome Angioneurotic Edema Congestive Heart Failure Liver Cell Failure-edema start in face-2-8y-heavy proteinuria &oliguria-hypoalbuminemia &hypercholesterolemia
-edema more in eyelids &lips-ass. with urticarial wheals-itching allergic
-cardiac lesion-congestive neck vein,enlarged tender liver,edema LL-ascites
-jaundice, foetorhepaticus, flappingtremors-ascites-impaired liver function