Download Q 1 Define nephritoc syndrome. Enumerate its common causes and

Q 1 Define nephritoc syndrome. Enumerate its common causes and discuss management outlines
for this syndrome. 4+6+10=20
Ans – Nephrotic syndrome is a clinical complex characterised by number of renal and extrarenal
conditionsProteinuria
Hypoalbuminemia
Oedema
Hyperlipidemiahypercoagulablity
Bacterial infection
More than 3.5 gm/24 hrs, it is due to increase glomerular permeability to
proteins of high molecular variety like albumin
Due to increase urinary excretion of albumin
Low oncotic pressure, first develop in loose part of the body like periorbital
edema and facial puffiness later may develop in generalised
edema(anasarca)
Stimulation of liver to produce lipids in respose to low plasma protein
Increased excretion of antithrombin3 and susquent production of
fibirongen it may cause renal vein thrombosis
Due to increase excretion of IgG in urine
Common causes1 glomerulonephritis- minimal change disease, membranoproliferative, Focal segmental
glomeruloscerosis
2 infections- HBV,HCV,HIV, malaria,syphilis
3 metabolic- diabetes
4 malignant diseases- leukemia. Myeloma
5 systemic diseases- SLE, rheumatoid,amyloid
6hereditary- alport,nail patella
7 hypersensitivity- Gold,snake bite, mercury
8 toxemia of pregnancy
Management –
1 treatment of the symptoms
2 underlying disease
3 preventing complications
1 symptomatic treatment

Nephrotic syndrome is presented with edema. Mild edema can be treated by fluid
restriction and low Na intake in diet. However significant edema requires treatment in the
form ofFluid restriction to 1 litre / day
Na intake- 1-2gm/day
Diuretics – furosemide 80-200 mg/day in divided doses, can be accompanied with
spironolactone

Proteinuria is treated with ACE inhibitors or ARBs as these drugs reduce intraglomerular
pressure.
Captopril- 6.25-25 mg/day in divided doses or Enalpril


Protein in diet should be limited to 0.8-1.0 gm/day of high quality and rich in essential amino
acids
Vit D supplementations
 Hyperlipidemia is treated by restricting high lipid diet and using statins
2 treatment of underlying diseasesMinimal change disease is usually steroid responsive. It is treated by prednisolone 40 mg/day for 4
weeks and then 35 mg/day for alternate days for another 4 weeks . other drugs likecyclophosphamide, cyclosporine, mycophenolate mofetil can be given in unresponsive cases.
Insulting agents should be removed like toxic drugs
3 treatment of complicationsa) Infections- spontaneous infections are common in nephrotic syndrome. Montoux test is
carried out to find TB. If it’s positive without any symptomatic TB , prophylactic INH for 6
months is given. Spontaneous peritonitis due to streptococcal infection is common.
b) Thrombosis- it is treated by anticoagulant therapy. LMWH followed by oral anticoagulant is
given
c) Acute renal failure- overzealous use of diuretics can cause fluid loss and renal
hypoperfusion.
d) Cushinoid features- due to steroid use, can be minimised by using other immunosuppressive
therapy.
Q 2 what are the symptoms of acute pyelonephritis?name the organisms.list the antibiotics to
treat severe pyelonephritis. 4+8+8=20
Ans – symptoms- 1 . fever with chills and rigor
2 flank pain may radiates towards iliac fossa and pubic region
3 hematuria
4 vomiting and nausea
Organismsa)
b)
c)
d)
e)
f)
E coli
Klebisella
Enterococcus
Pseudomonas
Streptococcus
Antibiotics

Fluroquinolones- ciprofloxacin 500 mg po BID for 7 to 10 days
Ofloxacin




TMP-SMX
Ampicilin with aminoglycosides- IV ampicillin+ IV gentamicin
Tazobactam+ Piperacillin
IV ceftriaxone- 1 gm/24 hrs