Nephrotic syndrome: Difference between revisions
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*Life-threatening complications are infection and thromboembolic events | *Life-threatening complications are infection and thromboembolic events | ||
== | ==Clinical Features== | ||
*Edema (face, periphery) | *Edema (face, periphery) | ||
*SOB, cough (pleural effusion, pulmonary edema) | *[[SOB]], cough ([[pleural effusion]], [[pulmonary edema]]) | ||
*Oliguria | *Oliguria | ||
== | ==Differential Diagnosis== | ||
*Primary nephrotic syndrome | |||
**Minimal-change, Membranoproliferative | |||
*Secondary nephrotic syndrome | |||
**SLE, HSP, SCD | |||
{{Periorbital swelling DDX}} | |||
==Diagnosis== | |||
*UA | *UA | ||
**Proteinuria, no hematuria | **Proteinuria, no hematuria | ||
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*Ultrasound | *Ultrasound | ||
**Only if suspect renal vein thrombosis - hematuria, flank pain, ARF | **Only if suspect renal vein thrombosis - hematuria, flank pain, ARF | ||
==Treatment== | ==Treatment== | ||
*Give IV fluids if | *Give IV fluids if evidence of hypovolemic shock (even if edema is severe) | ||
*Volume overload | *Volume overload | ||
**Treat | **Treat with [[furosemide]] 1-2mg/kg | ||
**May require correction of hypoalbuminemia first; 0.5-1gm/kg | **May require correction of hypoalbuminemia first; 0.5-1gm/kg | ||
*Steroids | *Steroids | ||
**Effective for minimal-change disease | **Effective for minimal-change disease | ||
**Prednisone 2mg/kg/d in 2-3 divided doses | **[[Prednisone]] 2mg/kg/d in 2-3 divided doses x 6 weeks | ||
*Low-salt diet | *Low-salt diet | ||
==Disposition== | ==Disposition== | ||
Admit | ===Admit=== | ||
*Severe edema | *Severe edema | ||
*Pulmonary effusion or respiratory symptoms | *Pulmonary effusion or respiratory symptoms | ||
*Infection or thrombotic complications | *Infection or thrombotic complications | ||
Outpt nephrology | |||
===Outpt nephrology follow up=== | |||
*Mild-moderate edema | *Mild-moderate edema | ||
== | ==References== | ||
[[Category:Peds]] | [[Category:Peds]] | ||
Revision as of 05:56, 13 August 2015
Background
- Increased permeability of glomerular capillary wall
- Proteinuria, hypoproteinemia (alb <3), edema, hyperlipidemia
- Life-threatening complications are infection and thromboembolic events
Clinical Features
- Edema (face, periphery)
- SOB, cough (pleural effusion, pulmonary edema)
- Oliguria
Differential Diagnosis
- Primary nephrotic syndrome
- Minimal-change, Membranoproliferative
- Secondary nephrotic syndrome
- SLE, HSP, SCD
Periorbital swelling
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- Ocular compartment syndrome
- Orbital tumor
No proptosis
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryocele/Dacryocystocele
- Dacryostenosis
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
Lid Complications
- Blepharitis (crusts)
- Chalazion (meibomian gland)
- Stye (hordeolum) (eyelash folicle)
Other
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Conjunctivitis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Sarcoidosis
- Granulomatosis with polyangiitis
Diagnosis
- 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
Treatment
- Give IV fluids if evidence of hypovolemic shock (even if edema is severe)
- Volume overload
- Treat with 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 x 6 weeks
- Low-salt diet
Disposition
Admit
- Severe edema
- Pulmonary effusion or respiratory symptoms
- Infection or thrombotic complications
Outpt nephrology follow up
- Mild-moderate edema