Nephrotic Syndrome

dr Putra Hendra SpPD

UNIBA
Nephrotic syndrome

Proteinuria >3.5g / 24 hours (Esbach)

Hypoalbuminaemia
Oedema
Hyperlipidaemia
Lipiduria
Hypercoagulability
Figure 1. Nephrotic edema.
Figure 2. Nephrotic edema.
 Differential Diagnosis
Transient proteinuria
Orthostatic proteinuria
Persistent proteinuria
 Transient Proteinuria
Proteinuria penyebab non-renal :
fever, exercise, CHF, seizures.
Membaik bila kondisi membaik.
Intermittent proteinuria: penyebab
tak jelas, prognosis baik.
 Orthostatic Proteinuria
Proteinuria disebabkan posisi berdiri.
Penderita berumur < 30 th dengan
proteinuria < 1.5 g/day.
Diagnosis: Jumlah protein siang>
malam
 Subnephrotic Proteinuria
Transient or orthostatic proteinuria
Hypertensive nephrosclerosis
Ischemic renal disease/renal artery
stenosis
Interstitial nephritis
 Mechanisms of Proteinuria
Jumlah protein filtrat
Melebihi kemampuan ginjal mereabsorbsi
protein

GFR (mild proteinuria)

Pregnancy, fever

Increased filtered protein

Myeloma, MGUS
Metabolic albumin turnover in healthy
subjects vs. subjects with nephrotic
syndrome.
 Physiology/Pathophysiology
Aliran Protein melalui renal arteries =
121,000 g/day
Filtrasi Protein melalui glomerulus = 1-2
g/day (< 0.001%)
Protein diexcresi urine < 150 mg/day
(<1% of filtered)
Composition urine normal: Tamm-Horsfall
protein 60-80%, albumin 10-20%.
Pathogenesis of nephrotic diseases
(Possible) consequences of proteinuria and lipid spectrum abnormalities.
Diagram showing pathogenetic factors leading to hypercoagulability,
tromboembolism and renal vein thrombosis.
Table 2 CAUSES OF THE NEPHROTIC SYNDROME
 Test protein

Adanya proteinuria merupakan tanda kelainan ginjal.

False negatives dapat terjadi pada:
alkaline urine
Pengenceran urine
Protein bukan albumin.
 Tata laksana
Specific therapies
DM Tx DM
immunosuppresive agents (corticosteroids,
cyclophosphamide, chlorambucil, cyclosporine A)
Nonspecific therapies
bloodpressure
metabolic control :Lipid control
Maximization of ACE inhibitor (captopril)
Supportive Care :
Edema: sodium restriction.Tx :diuretics,.
Infection: anti infeksi
Balance protein restriction
 Prognosis
Diabetic nephropathy: ESRD 10-20 th
setelah proteinuria.
Nephrotic syndrome: prognose jelek.