💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
Nephrotic syndrome IN CHILDREN Lecture for MBBS
1.
2.
3. Dr. Muhammad Sajjad Sabir
MBBS, DCH, MCPS, FCPS
Assistant Professor of Paediatrics
4. Manifestation of glomerular disease,
characterized by nephrotic range
proteinuria and a triad of clinical
findings associated with large urinary
losses of protein : hypoalbuminaemia ,
edema and hyperlipidemia
6. 15 x more common in children than adults
2 – 7 cases / 100,000 children / year (Global)
Incidence South Asia 16/100,000 children
Most common= 1.5 - 6 year
boys : girls --- 2:1
7. Defined as
Protein excretion of > 40 mg/m2
/hr
(>1g/m2
/24 hr)
Spot Protein : Creatinine > 2-3 : 1
(First morning urine sample)
- Nelson Textbook of Paediatrics, Vol 2, 19th
Edition, page 1801
25. DIETARY ADVICE:
Balanced diet = adequate proteins & calories
Foods high in sodium avoided
High protein diet
Edema no added salt
Treatment of infections
Parent Education
Can attend school
Can participate in physical activities as tolerated
26. If significant edema
Diuretics + Aldosterone antagonist
( Fursemide, spironolactone )
Salt restriction
DIURETICS INDICATIONS:
Severe symptomatic edema
Steroid toxicity or steroid contraindicated
Q.Best diuretic in Nephrotic Syndrome?
27. ROLE OF INTRAVENOUS ALBUMIN
INDICATIONS:
Signs of hypovolemia
Sever oedema
DOSAGE & ADMINISTRATION:
I/V salt poor 25% albumin infusion
0.5-1 gm/kg/dose over 6-12 hrs + I/V
Frusemide 1-2 mg/kg
28. DOSAGE & ADMINISTRATION:(after a -ve PPD test)
Prednisolone 60mg/m2
/day (max 80mg)
As single am daily dose {or 2-3 dd} for 6 wks
After the initial 6-wk course,
Prednisone dose tapered to 40 mg/m2
/day given
every other day as a single daily dose for at
least 6 wk.
Alternate-day dose then slowly
tapered→discontinued over next 1-2 mo
30. REPONSE TO STEROID:
80-90% children respond within 3 wk
10% respond by first week
70% by second week
85% by third week
92% by forth week
Who respond to prednisone therapy
do so within first 5 wk of treatment
31. STEROID DEPENDENT: Patients who relapse while
on alternate-day steroid therapy or within 28 days of
completing a successful course of prednisone therapy
FREQUENT RELAPSERS: Patients who respond
well to prednisone therapy but relapse ≥ 4 times in
a 12-mo period
INFREQUENT RELAPSERS :3 or less relapses per yr
STEROID RESISTANT: Fail to respond to
corticosteroid therapy within 8 wks
Children who continue to have proteinuria (2+ or greater)
Diagnostic renal biopsy should be performed
32. Relapses should be treated with:
Prednisone 60 mg/m2
/day (80 mg daily max)
As single am dose
Until child enters remission (urine trace or
negative for protein for 3 consecutive days)
Then prednisone changed to alternate-day
(40 mg/m2
/day )
Gradually tapered over 4-8 wk