Syndromes in Nephrology

Acute nephritis
Nephrotic syndrome
Asymptomatic urinary abnormalities
Acute renal failure
Chronic kidney disease
Urinary tract infection
Urinary tract obstruction
Nephrolithiasis
Hypertension
Renal tubular defects
 Cross-Section of the Kidney

Nephron

Renal Medulla
Renal Vein
Papilla Renal Artery
Renal Cortex Renal Pelvis
Branch of the Ureter
Renal Vein
Branch of the
Renal Artery

RENAL ANAEMIA
 Manifold Tasks of the Kidney
Bone Structure
Metabolic Blood Formation
End Products
Calcium Vitamin D
Balance Activation

Erythropoietin
Removal of Synthesis
Urea, Creatinine etc.
Functions
Water Balance
Potassium
Balance

Recovery of Sodium
Bicarbonate Removal
Blood Pressure
Cardiac Activity
Regulation of Blood pH

RENAL ANAEMIA
NEPHROTIC SYNDROME

SYAKIB BAKRI, HASYIM KASIM, HAERANI RASYID

*Division of Nephrology, Department of Internal Medicine

Faculty of Medicine, Hasanuddin University
 Glomerulopathies

Glomerulopathy : a group of diverse conditions – including, but not limited

to, glomerulonephritis – having in common the fact that the disease
process begins in the glomerulus or that the glomerulus is the most
importantly diseased part of the nephron.

Glomerulopathies are the most common causes of end-stage renal disease

Clinical presentation of glomerular disease

I. Acute glomerulonephritis
II. Rapidly progressive glomerulonephritis
III. Chronic glomerulonephritis
IV. Persistent urinary abnormalities with few or no symptoms
V. Nephrotic syndrome
Nephrotic syndrome

• Clinical entity having miltiple causes and characterized

by increased glomerular permeability manifested
by massive proteinuria and lipiduria.
• Massive proteinuria > 3.5 g/day/1.73m2 body surface area
in the absence of a depressed GFR.
 Clinical Features of The Nephrotic Syndrome

Manifestations of the nephrotic syndrome itself

Signs and symptoms determined by the underlying disease

involving the kidney
Clinical manifestation of nephrotic syndrome :

Oedema
Hypertension
Dyslipidemia
Hypercoagulable state
Hypoproteinemia / proteinuria
Progressive renal failure
Trace metal deficiencies
Endocrine disturbances
Infectious / immunodeficiency states
Pathophysiology of the Nephrotic Syndrome
 Classification of the disease states associated with the development of
nephrotic syndrome

I. Idiopathic nephrotic syndrome due to Primary Glomerular Disease

II.Nephrotic syndrome associated with spesific etiologic events or in which

glomerular disease arises as a complication of other disease

1. Medications
2. Allergens
3. Infection ( bacterial, viral, protozoal, helminthic )
4. Neoplasmic ( solid tumors, leukemia and lymphoma )
5. Multisystem disease
6. Heredofamilial and metabolic disease
7. Miscellaneous
Diagnostic approach in nephrotic syndrome

I. Clinical
II. Laboratory studies
III. Renal biopsy
I. Clinical

History
Preexisting disease
Previous infection
Drug ingestion
Arthritis, rash
Current pregnancy
Family history of renal disease

Physical examination
Severe obesity
Rash, arthritis
Diabetic retinopathy
Hypertension
Evidence of malignancy
Lipodystrophy
Lymphoadenopathy/hepatosplenomegaly
II. Laboratory Studies

Urinalysis

In all cases ( nondiagnstic )

Creatinine clearance
Serum protein electrophoresis
Serum tota;cholesterol, lipoprotein
Serum ionized calcium
Parathyroid hormone

In selected cases ( to establis the diagnosis )

Complement level
Antinuclear antibody assay
Cryoglobulins
Hepatitis and HIV serology
Serum and urine immunoelectrophoresis
III. Renal biopsy

• Minimal change disease

• Focal segmental glomerulosclerosis
• Membranous nephropathy
• Membranoproliferative glomerulonephritis
• Other glomerulonephritis
 Suggested approach for initial treatment
( Minimal change disease )

Children
Prednisone 60 mg/m2/day until remission, then 40 mg/m2/48 h for
12 weeks, then reduce by 5-10 mg/m2/48 h every month.

Adults
Prednisone 1mg/kg/day until remission or for 6 weeks, then 1.6 mg/kg/48 h
for 1 month, then reduce by 0.2-0.4 mg/kg/48 h.

Elderly
Prednisone 1 mg/kg/day until remission or for 4 weeks, then 0.8 mg/kg/day
for 2 weeks, then 1.6 mg/kg/48 h for 2 weeks. Then reduce by 0.4 mg/kg/48 h
every 2 weeks. If no remission continue with 1.2 mg/kg/48 h for another
4 weeks then reduce.

Contraindications to prednisone
Cyclophosphamide 2 mg/kg/day or chlorambucil 0.15mg/kg/day for 8-12
weeks
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