Nephrotic syndrome

Syndrome néphrotique

– The definition is biological:

• proteinuria 50 mg / kg / 24 hours in children and 3 g / 24 hours in adults

• hypoalbuminemia less than 30 g / liter

• hypoproteinemia less than 60 g / liter

– Clinically, edema and oliguria are often associated, but not always.

We distinguish :

– The pure nephrotic syndrome (or isolated)

• due to early nephropathy, which may be sensitive or not to corticosteroids, variable prognosis according to treatment response, rare in the tropics;

• absence of hypertension, haematuria, renal failure.

– The impure nephrotic syndrome (or associates)

• due to a primitive or secondary nephropathy nephropathy another disease (diabetes, infections, parasitic infections, collagen), usually resistant to corticosteroids, very reserved prognosis, of far the most frequent in the tropics;

• presence of hypertension, micro / macroscopic hematuria and renal failure.

Nephrotic syndromeTreatment:

Pure nephrotic syndrome:

– Corticosteroids: prednisolone PO

Child: 2 mg / kg / day in 2 divided doses for 4 weeks, not to exceed 60 mg / day and 2 mg / kg / 48 hours in a single dose in the morning for 8 weeks and then phase out over a period of 6 weeks: 0.5 mg / kg / 15 days for a total duration of treatment of 4 to 5 months.

Adult: same pattern as in children with prednisolone initial dose of 1 mg / kg / day in a single dose in the morning.

remarks:

• The response to treatment is obtained in 10 to 15 days.

• Relapses are more frequent in case of too rapid dose reduction.

• A relapse when decreasing doses of corticosteroids sign corticosteroid and justifies a longer corticosteroids, which raises the issue of tolerance and supervision. then one can be forced to deal with a pure nephrotic syndrome as a nephrotic syndrome.

• A no response after 4 weeks of good conduct cortico-steroids sign a resistance and requires treatment discontinuation. Treat as nephrotic syndrome.

• For adults, the response to steroids is slower than in children but relapses are less frequent.

– Complementary Treatments:

• Restrict salt and water.

• Plan calorie, high protein.

• Avoid bed rest: increased risk of thromboembolic complications.

• very careful use of diuretics when significant edema resistant to water and sodium restriction (see treatment of impure nephrotic syndrome below).

• Early detection and treatment of infectious complications associated outbreaks.

• In case of hypovolemia, see treatment of impure nephrotic syndromes below.

Nephrotic syndromes unclean:

– Diuretics only in case of significant edema prudent use to avoid dehydration or hemoconcentration, risk factors for occurrence of thromboembolic events.

child:

furosemide PO initial dose of 1 mg / kg / day in a partner taking spironolactone PO initial dose of 2 to 3 mg / kg / day in 2 divided doses and then gradually reduce the dose and adjust according to the clinical course avoiding the effects rebounds.

Adult :

furosemide PO initial dose of 20-40 mg / day in a partner taking spironolactone PO: initial dose of 50 to 100 mg / day in 2 divided doses and then gradually reduce the dose and adjust according to the clinical course avoiding effects rebounds.

– If effective hypovolemia:

child:

macromolecules (polygeline or modified fluid gelatin): 20 ml / kg over 2 to 3 hours followed by furosemide IV: 1 mg / kg to possibly renew once (at least 2 hours after the first injection) according to TA.

Adult :

macromolecules (polygeline or modified fluid gelatin): A 500 ml flask followed IV furosemide: 20 to 40 mg to optionally repeated once (at least 2 hours after the first injection) by the TA.

– Complementary Treatments:

• Restrict salt and water.

• Plan calorie, high protein.

• Avoid bed rest: increased risk of thromboembolic complications.

• Screening and early treatment of infectious complications associated outbreaks.

• Treatment of the underlying disease associated if it is found.