SINDROM NEFROTIK (SN)

SN. Diatandai dengan

1. Proteinuri > 3,5 gr/hari
2. Hipoalbuminemi < 35 gr/L
3. Sembab lokal atau umum
4. Hiperkolesterolemi

Klasifikasi:
1. Primary Glomerular Disease
a. Membraneus
b. Proliferative dan fokal
c. Membrano proliferative
d. Minimal lesi
2. Penyakit-penyakit lain
a. DM
b. SLE
c. Amiloid

Sembab

1 Sindrom Nefrotik
Cause of nephritic syndrome (primary glomerular disease)

Proteinuria
- Perubahan permeabilitas dinding glomerular dan/atau
- Defek pada uptake tubular

Glomerular filtration of proteins

Increase in tubular protein load

Gambaran klinis:
- Sembab
- Gizi jelek
- Pucat

Clinical characteristics
- Edema formation
- Hyperlipidemia
- Thrombo-embolic complications (esp. membranous glomerulopathy)
- Infection
Pengobatan
- Simptomatis dan suportif

2 Sindrom Nefrotik
 - Pengobatan etiologi

Therapy: removal of anemia

Induction of a negative sodium balance by:
- Diet
 Reduction of sodium intake (3g/day)
- Diuretics
 Loop diuretics, administration 2-3 times/day (short half life), high dose/IV if
necessary
o Maximal dose : furosemide 500-100 mg/day
o Maximal dose: bumetanide 10 mg/day
 Combination with thiazide diuretics

Theraphy: reduction of proteinuria

- Dietary intervention
 Low salt diet (3g/day)
o Increases effect of ACE-inhibitors and diuretics
 Protein restriction (NO high protein intake)
- ACE-inhibition
 Even in normotensive patient
 Dissociation between effect on blood pressure and effect on proteinuria
- (NSAID’s; partially mediated by reduction of GFR)

Therapy: treatment of primary disease

- Immunologic intervention depending on diagnosis (renal biopsy)
 Minimal change nephropathy: corticosteroid
 FSGS: corticosteroid
 MGN: wait and see, if no remission after 6 months: corticosteroid with alkylating
agents

Prognosis
Penyebab kematian
- GGK
- Infeksi
- Hipertensi berat

3 Sindrom Nefrotik