Management of Nephrotic Syndrome ?

(Mnemonic + Notes )

Nephrotic syndrome is an important question asked frequently in the MBBS exam!
Here are some of my notes on nephrotic syndrome, in case you wanna refer and add some extra points to yours
Also included some memory aids and mnemonics that I use.

Definition and causes of Nephrotic Syndrome:
​

"Manifestation of glomerular disease" sounds more elegant than simply writing the triad in the definition.


In causes, make sure you write Minimal change disease, Malaria, focal Segmental glomerulosclerosis, Sickle cell disease, Heroin and HIV. They are important causes. If you can remember one, there is another one with the same alphabet.

Pathophysiology and clinical features of nephrotic syndrome:
​

What causes hypoalbuminemia?
Increased permeability of the glomerular capillary wall.

What causes edema?
Decrease in oncotic pressure causes exudation of fluid from the intravascular compartment to the extravascular space.

What causes fluid retention?
The activation of Renin Angiotensin Aldosterone system causes retention of salt.
Antidiuretic Hormone causes retention of water.

What causes hyperlipidemia?
Hypoalbuminemia causes increased synthesis of proteins in the liver, including lipoproteins. There is loss of lipoprotein lipase in urine.

Why is there an increased risk of thrombosis?
Hypoalbuminemia causes increased synthesis of proteins in the liver, including coagulation factors. There is loss of antithrombin III in urine. Vascular stasis, increased platelet production are other causes.

Why is there an increased susceptibility to infections? Like sepsis, peritonitis and pyelonephritis especially with encapsulated organisms such as Haemophilus influenza and Streptococcus pneumonia?
There is loss of complement, opsonins and immunoglobulins in urine. Risk is also increased because of the immunosuppressants used to treat the disease.

Diagnosis and investigations in nephrotic syndrome:

This part is simple, actually.

Management of nephrotic syndrome mnemonic below!​

Prednisone
60 mg/m2/kg for 6 weeks daily... 60, 6 easy!
40 mg/m2/kg for 4 weeks alternate day… 40, 4 easy!

​

Management of nephrotic syndrome relapse:

Steroid resistant, frequent relapsers and steroid dependent treatment mnemonic below!​

P and R are the key alphabets.
CycloPhosphamide and MycoPhenolate mofetil in steroid dePendent and frequent relaPsers.

CyclospoRine and TacRolimus in steroid Resistant.
-------------------------------------------------------------------
Finished!

 

thanks for sharing sir