CASE REPORT

NEPHROTIC SYNDROME
Compiled by :
SANTA YOHANA (110100282)
RENJITHA GURUNATHAN (110100386)
Supervised by :
dr. Hj. Lily Irsa, M.Ked (Ped), Sp.A(K)
CHILD HEALTH DEPARTMENT
HAJI ADAM MALIK GENERAL HOSPITAL
FACULTY OF MEDICINE
SUMATERA UTARA UNIVERSITY
MEDAN
2015

INTRODUCTION

DEFINITION

Proteinuria
Proteinuria
>40mg/m/h
>40mg/m/h

Hyperlipide
Hyperlipide
mia
mia
>200mg/dL
>200mg/dL

NEPHROTIC
NEPHROTIC
SYNDROME
SYNDROME

Edema
Edema

Hypoalbum
Hypoalbum
inemia
inemia
<2.5
<2.5g/dL
g/dL

EPIDEMIOLO
GY

In the United States, incidence rate of NS is 2-7 cases per 100,000 children per
year.
Cumulative prevalence rate is approximately 16 cases per 100,000 individuals.
More common in boys than girls in younger age groups, but once adolescence
is reached there is no significant difference between genders.
Most commonly seen at ages 3 to 5.

CLASSIFICATION
NEPHROTIC SYNDROME

Primary/Idiopathic

Secondary
Metabolic/congenital
disease (DM, amyloidosis,
Alport syndrome)

Infections (hep.B , malaria,

syphilis, AIDS)

Toxin and allergens

( penicillamine,
probenecid, insect venom,
nake venom)

Systemic immunologic
disease ( SLE, sarkoidosis)

Neoplasma ( lung tumors,

Hodgkin's disease)

Congenital

Minimal change disease

Membranous GN

Focal segmental
glomerulosclerosis

Membranoproliferative
GN

lgA nephropathy

Inflammatory reaction

PATHOPHYSIOLOGY
OF NEPHROTIC
SYNDROME

Dearrangement in
capillary walls of
glomeruli
Increase
permeability to
plasma protein
Allows protein to
escape from plasma to
glomerular filtrate

Proteinuria

Fluid escape into

tissues

Edema

CLINICAL FEATURES
Swelling (edema) is the most common symptom. It may occur:
In the face and around the eyes (facial swelling)
In the arms and legs, especially in the feet and ankles
In the belly area (swollen abdomen)
Other symptoms include:
Weight gain
Respiratory tract infection
Allergy
Respiratory distress
Diarrhea

TREATMENT
Relief of edema. 1. salt restriction.
2. Fluid intake. 3. mild diuresis.4. Dietary
protein.
Remission can be induced by Prednisolone
60mg/m2/ day divided into 3 or 4 doses. The average time
needed for response is about two weeks.
After the initial 6 weeks course, prednisolone is tapered to
40mg/m2/day given every other day as a single morning
dose. The alternate day dose is then slowly tapered and
discontinued over the next 2-3 months.
Steroid dependent and frequent relapsers may have
prolonged remissions on alternative drugs like
cyclophosphamide, cyclosporin A, tacrolmus and
mycophenolate

COMPLICATIONS
Infection. Peritonitis is the most frequent type of
infection. Pneumonia, Cellulitis, urinary tract
infection and sepsis are also encountered.
Increased tendency to arterial and venous
thrombosis.
Side effects of prolonged steroid therapy.
Hyperlipidemia

Discussion
THEORY

CASE

Nephrotic syndrome is defined by the

presence of proteinuria, edema,
hyperlipidemia, and hypoalbuminemia.

In this patient, all the

characteristics of nephrotic
syndrome based on the
theories occur, such as;
proteinuria (2+), edema, and
hypoalbuminemia (1.2 g/dl).

Clinical manifestation of nephrotic

syndrome are:
Edema :
+ In the face and around the eyes
+ In the arms and legs, especially in
the feet
and ankles
Foamy apperance of the urine
Weight gain
Ascites or Pleral effusions
Decliing urine output
Anorexia
Abdominal discomfort

In this patient, the same

clinical manifestations based
on the theories occur, such
as: swelling on her whole
body, weight gain, and
hypertension.

11/4/15

CONCLUSION
MFF, a boy, 6 years 7 months, came to RSUP Haji Adam Malik Medan on
29

th

Sept 2015, with chief complaint of swelling on face and giving

treatment with
-

Inj. Ceftriaxone 1 gr q12 h

Furosemid PO 40 mg q 8 h

Aspilet 80 mg PO q24 h

Aldacton 25 mg PO q8h

Captopril

Valsartan 80 mg tab PO q 24h

Natrium bicarbonate 2-1-1 tab

Prednisolon alternative dose 408/m2

12.5 mg PO q 12 h

11/4/15

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