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•Hepatitis B •Syphilis
2. Infections •Malaria •Filariasis
•Leprosy •Schistosomiasis
cartilagenous tissue
small nose, wide-set eyes, low-set ears
Prognosis : infaust
IDIOPATHIC NEPHROTIC SYNDROME
1. Minimal change
2. Focal segmental glomerulosclerosis
3. Proliferative glomerulonephritis
Mesangial
Focal
Diffuse exudative
Mesangiocapillary (membrano-proliferative)
4. Membranous glomerulonephritis
5. Advance chronic glomerulonephritis
Penegakkan diagnosis sindrom nefrotik
didasarkan pada anamnesis, pemeriksaan
fisis, dan pemeriksaan penunjang.
Generelised edema
(anasarca)
Pitting peripheral
oedema
Ascites
SCROTAL EDEMA LABIAL EDEMA
LABORATORY FINDINGS
Urinary analysis:
pH
proteinuria massive
(selective - albumin 85-95%)
qualitative/semiquantitative > 2+
quantitative : Esbach
leukocyturia
haematuria
double refractile lipoid bodies
hyaline cast
Plasma :
Hb , Ht
hypoalbuminaemia, reverse ratio alb/glob
hypercholesterolaemia
normal: ureum, creatinine
Remission
◦ Urinary protein < 4 mg/ m2hr or Albustix = 0/Trace
for 3 consecutive days
Steroid Responsive
◦ Remission with steroids alone
Relapse
◦ Urinary protein > 40 mg/m2*hr or Albustix > 2+ for 3
consecutive days
Frequent Relapses
◦ Two or more relapses within 6 months of initial
response or 4 or more relapses within any 12 month
period
Steroid Dependence
◦ Two consecutive relapses occurring during corticosteroid
treatment or within 14 days of its cessation
Steroid Resistance
◦ Failure to achieve response in spite of 4 weeks of
prednisone 60 mg/m2*day
Pengobatan dengan prednison
SNRS : Imunosupresan
Edema Anasarka : Tirah baring
Pengobatan suportif ;diet nefrotik & diuretik.
Hipertensi : Antihipertensi
Pemberian albumin/plasma jika ada indikasi
edema refrakter, gagal ginjal akut, atau syok.
TREATMENT
1. Medication
1. STEROID
2. DIURETICS
3. IMMUNOSUPRESSIVE AGENTS
2.Dietary (nephrotic diet)
LOW SALT (1-2 g/day)
PROTEIN 2-3 g/kg/day
3. OPTIMIZING CONDITION
(physic,psychology,social)
- Activity : not limited
- Immunization: as scheduled
- Psychological support : the child + parents
FOLLOW UP
OUT PATIENT CLINIC:
- Symptomatic : weekly - monthly
- Asymptomatic : every 3-6 months (renal
function evaluation)
ADMISSION :
generelized oedema, severe hypertension,
severe infection, shock, acute renal failure, initial
attack nefrotik syndrome
STANDARD TREATMENT
CORTICOSTEROID (PREDNISON)
INITIAL TREATMENT
4 MINGGU 4 MINGGU
Prednison FD: 60 mg/m2/day
Prednison AD: 40 mg/m2/day
STEROID RESISTANT
IMMUNOSUPRESSIVE AGENTS