Nephrotic syndrome - Revision history

Danbot: Add MedicationDose entry for prednisone

2026-03-20T21:14:41Z

Add MedicationDose entry for prednisone

@@ Line 69: / Line 69: @@
 ===Outpatient nephrology follow up===
 *Mild-moderate edema
 ==References==

Kfarzam: /* Evaluation */

2022-08-18T07:22:32Z

Evaluation

← Older revision		Revision as of 07:22, 18 August 2022
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	**Serum albumin < 25 g/L		**Serum albumin < 25 g/L
	*Lipid panel, with total cholesterol > 380mg/dL (10 mmol/L)		*Lipid panel, with total cholesterol > 380mg/dL (10 mmol/L)
	*ANA, C3, C4, [[viral hepatitis]] panel		*ANA, C3, C4, [[viral hepatitis]] panel, HIV, SPEP, SIFE, UPEP, ANCA, free light chains, PLA2R
	*[[CXR]] (only if suspect pleural effusion / pulmonary edema)		*[[CXR]] (only if suspect pleural effusion / pulmonary edema)
	*[[Renal ultrasound]]		*[[Renal ultrasound]]

Kfarzam: /* Differential Diagnosis */

2022-08-18T07:21:22Z

Differential Diagnosis

← Older revision		Revision as of 07:21, 18 August 2022
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	*Classical characteristics/risk factors:		*Classical characteristics/risk factors:
	**Minimal change disease - children, preceded by [[URI]]		**Minimal change disease - children, preceded by [[URI]]
	**Focal segmental glomerulosclerosis - Black patients, [[HIV]]/[[IVDA]]		**Focal segmental glomerulosclerosis - Black patients, [[HIV]]/[[IVDA]], specific anabolic steroids
	**Membranous nephropathy - ~~White~~ patients, [[HBV]], [[hepatitis C\|HCV]], [[SLE]], gold, [[penicillamine]], malignancy		**Membranous nephropathy - Caucasian patients - primary etiology, [[HBV]], [[hepatitis C\|HCV]], [[SLE]], gold, [[penicillamine]], malignancy
	**Type 1 MPGN - [[HBV]], [[hepatitis C\|HCV]]		**Type 1 MPGN - [[HBV]], [[hepatitis C\|HCV]]
	**Type 2 MPGN - ↓ C3		**Type 2 MPGN - ↓ C3

Elcatracho: /* Management */

2021-02-21T02:45:07Z

Management

← Older revision		Revision as of 02:45, 21 February 2021
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	*[[fluid overload\|Volume overload]]		*[[fluid overload\|Volume overload]]
	**Treat with [[furosemide]] 1-2mg/kg		**Treat with [[furosemide]] 1-2mg/kg
	**May require correction of [[hypoalbuminemia ~~first~~]]; 0.5-1gm/kg		**May require correction of [[hypoalbuminemia]] first; 0.5-1gm/kg
	*[[Steroids]]		*[[Steroids]]
	**Effective for minimal-change disease		**Effective for minimal-change disease

SeanDenny: /* Differential Diagnosis */

2020-12-15T00:26:47Z

Differential Diagnosis

← Older revision		Revision as of 00:26, 15 December 2020
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	**Focal segmental glomerulosclerosis - Black patients, [[HIV]]/[[IVDA]]		**Focal segmental glomerulosclerosis - Black patients, [[HIV]]/[[IVDA]]
	**Membranous nephropathy - White patients, [[HBV]], [[hepatitis C\|HCV]], [[SLE]], gold, [[penicillamine]], malignancy		**Membranous nephropathy - White patients, [[HBV]], [[hepatitis C\|HCV]], [[SLE]], gold, [[penicillamine]], malignancy
	**Type 1 MPGN - [[HBV]], [[HCV]]		**Type 1 MPGN - [[HBV]], [[hepatitis C\|HCV]]
	**Type 2 MPGN - ↓ C3		**Type 2 MPGN - ↓ C3

Rossdonaldson1: /* Management */

2020-05-21T15:07:42Z

Management

← Older revision		Revision as of 15:07, 21 May 2020
Line 54:		Line 54:
	*[[fluid overload\|Volume overload]]		*[[fluid overload\|Volume overload]]
	**Treat with [[furosemide]] 1-2mg/kg		**Treat with [[furosemide]] 1-2mg/kg
	**May require correction of hypoalbuminemia first; 0.5-1gm/kg		**May require correction of [[hypoalbuminemia first]]; 0.5-1gm/kg
	*[[Steroids]]		*[[Steroids]]
	**Effective for minimal-change disease		**Effective for minimal-change disease

ClaireLewis at 17:29, 16 October 2019

2019-10-16T17:29:46Z

← Older revision		Revision as of 17:29, 16 October 2019
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	==Background==		==Background==
	*Increased permeability of glomerular capillary wall		*Increased permeability of glomerular capillary wall
	**Proteinuria, [[hypoalbuminemia\|hypoproteinemia]] (albumin <3), edema, hyperlipidemia		**[[Proteinuria]], [[hypoalbuminemia\|hypoproteinemia]] (albumin <3), edema, hyperlipidemia
	*Life-threatening complications are [[infection]] and [[thromboembolism\|thromboembolic events]]		*Life-threatening complications are [[infection]] and [[thromboembolism\|thromboembolic events]]

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	==Evaluation==		==Evaluation==
	*[[Urinalysis]]		*[[Urinalysis]]
	**Proteinuria > 3.5 g/24 hr, no hematuria		**[[Proteinuria]] > 3.5 g/24 hr, no hematuria
	**Spot urine protein : urine creatinine ratio of > 3 - 3.5mg/mg (300 - 350mg/mmol)		**Spot urine protein : urine creatinine ratio of > 3 - 3.5mg/mg (300 - 350mg/mmol)
	*CBC		*CBC

ClaireLewis: /* Differential Diagnosis */

2019-10-06T18:53:19Z

Differential Diagnosis

← Older revision		Revision as of 18:53, 6 October 2019
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	**Minimal-change, membranoproliferative		**Minimal-change, membranoproliferative
	*Secondary nephrotic syndrome		*Secondary nephrotic syndrome
	**[[SLE]], [[HSP]], [[SCD]]		**[[SLE]], [[HSP]], [[sickle cell\|SCD]]
	*Classical characteristics/risk factors:		*Classical characteristics/risk factors:
	**Minimal change disease - children, preceded by [[URI]]		**Minimal change disease - children, preceded by [[URI]]
	**Focal segmental glomerulosclerosis - Black patients, [[HIV]]/[[IVDA]]		**Focal segmental glomerulosclerosis - Black patients, [[HIV]]/[[IVDA]]
	**Membranous nephropathy - White patients, [[HBV]], [[HCV]], [[SLE]], gold, [[penicillamine]], malignancy		**Membranous nephropathy - White patients, [[HBV]], [[hepatitis C\|HCV]], [[SLE]], gold, [[penicillamine]], malignancy
	**Type 1 MPGN - [[HBV]], [[HCV]]		**Type 1 MPGN - [[HBV]], [[HCV]]
	**Type 2 MPGN - ↓ C3		**Type 2 MPGN - ↓ C3

ClaireLewis at 18:52, 6 October 2019

2019-10-06T18:52:43Z

← Older revision		Revision as of 18:52, 6 October 2019
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	==Background==		==Background==
	*Increased permeability of glomerular capillary wall		*Increased permeability of glomerular capillary wall
	**Proteinuria, hypoproteinemia (~~alb~~ <3), edema, hyperlipidemia		**Proteinuria, [[hypoalbuminemia\|hypoproteinemia]] (albumin <3), edema, hyperlipidemia
	*Life-threatening complications are infection and thromboembolic events		*Life-threatening complications are [[infection]] and [[thromboembolism\|thromboembolic events]]

	==Clinical Features==		==Clinical Features==
	*Edema (face, periphery)		*Edema (face, periphery)
	*[[~~shortness~~ of breath]], cough ([[pleural effusion]], [[pulmonary edema]])		*[[Shortness of breath]], cough ([[pleural effusion]], [[pulmonary edema]])
	*Oliguria		*Oliguria

			===Complications<ref>Park SJ and Shin JI. Complications of nephrotic syndrome. Korean J Pediatr. 2011 Aug; 54(8): 322–328.</ref>===
			*Chronic high dose steroid adverse effects
			*[[Pulmonary embolism]]
			*[[Renal vein thrombosis]]
			*[[hypovolemia\|Hypovolemic]] crisis
			*[[Acute kidney injury]]
			*[[Infection]]
			*Cardiovascular issues (hyperlipidemia)
			*[[Anemia]]
			*[[Hypocalcemia]]
			*[[Hypothyroidism]]
			*[[Intussusception]]

	==Differential Diagnosis==		==Differential Diagnosis==
	*Primary nephrotic syndrome		*Primary nephrotic syndrome
	**Minimal-change, ~~Membranoproliferative~~		**Minimal-change, membranoproliferative
	*Secondary nephrotic syndrome		*Secondary nephrotic syndrome
	**[[SLE]], [[HSP]], [[SCD]]		**[[SLE]], [[HSP]], [[SCD]]
	*Classical characteristics/risk factors:		*Classical characteristics/risk factors:
	**Minimal change disease - children, preceded by [[URI]]		**Minimal change disease - children, preceded by [[URI]]
	**Focal segmental glomerulosclerosis - Black patients, [[HIV]]/IVDA		**Focal segmental glomerulosclerosis - Black patients, [[HIV]]/[[IVDA]]
	**Membranous nephropathy - White patients, HBV, HCV, SLE, gold, penicillamine, malignancy		**Membranous nephropathy - White patients, [[HBV]], [[HCV]], [[SLE]], gold, [[penicillamine]], malignancy
	**Type 1 MPGN - HBV, HCV		**Type 1 MPGN - [[HBV]], [[HCV]]
	**Type 2 MPGN - ↓ C3		**Type 2 MPGN - ↓ C3

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	**Serum albumin < 25 g/L		**Serum albumin < 25 g/L
	*Lipid panel, with total cholesterol > 380mg/dL (10 mmol/L)		*Lipid panel, with total cholesterol > 380mg/dL (10 mmol/L)
	*ANA, C3, C4, ~~Hep~~ panel		*ANA, C3, C4, [[viral hepatitis]] panel
	*[[CXR]] (only if suspect pleural effusion / pulmonary edema)		*[[CXR]] (only if suspect pleural effusion / pulmonary edema)
	*~~Ultrasound~~		*[[Renal ultrasound]]
	**Only if suspect renal vein thrombosis - hematuria, flank pain, ~~ARF~~		**Only if suspect renal vein thrombosis - [[hematuria]], [[flank pain]], [[AKI]]

	==Management==		==Management==
	*Give IV fluids if evidence of hypovolemic shock (even if edema is severe)		*Give [[IV fluids]] if evidence of [[hypovolemic]] [[shock]] (even if edema is severe)
	*Volume overload		*[[fluid overload\|Volume overload]]
	**Treat with [[furosemide]] 1-2mg/kg		**Treat with [[furosemide]] 1-2mg/kg
	**May require correction of hypoalbuminemia first; 0.5-1gm/kg		**May require correction of hypoalbuminemia first; 0.5-1gm/kg
	*Steroids		*[[Steroids]]
	**Effective for minimal-change disease		**Effective for minimal-change disease
	**[[Prednisone]] 2mg/kg/d in 2-3 divided doses x 6 weeks		**[[Prednisone]] 2mg/kg/d in 2-3 divided doses x 6 weeks
	*Low-salt diet		*Low-salt diet
	*Prophylactic anticoagulation for thromboembolic events not recommended, unless patient had previous thrombotic events		*Prophylactic anticoagulation for thromboembolic events not recommended, unless patient had previous thrombotic events

	~~==Complications<ref>Park SJ and Shin JI. Complications of nephrotic syndrome. Korean J Pediatr. 2011 Aug; 54(8): 322–328.</ref>==~~
	*Chronic high dose steroid adverse effects
	*[[Pulmonary embolism]]
	*[[Renal vein thrombosis]]
	*Hypovolemic crisis
	*[[Acute kidney injury]]
	*Infection
	*Cardiovascular issues (hyperlipidemia)
	*[[Anemia]]
	*[[Hypocalcemia]]
	*[[Hypothyroidism]]
	*[[Intussception]]

	==Disposition==		==Disposition==
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	[[Category:Pediatrics]]		[[Category:Pediatrics]]
			[[Category:Renal]]

Kxl328: /* Management */

2018-11-08T03:35:11Z

Management

@@ Line 47: / Line 47: @@
 *Low-salt diet
 *Prophylactic anticoagulation for thromboembolic events not recommended, unless patient had previous thrombotic events
 ==Disposition==