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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

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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