Obat-obat pada syndrome

nefrotik(SN/NS)
 batasan
NS is an accumulation of
symptoms and signs and is
characterized by proteinuria,
hypoproteinemia, edema, and
hyperlipidemia.
 pada anak<5th biasanya
merupakan idiopatik/primary
neprotic syndrome).
 Type
1.Clinical type
Simple NS ; Nephritic NS
2.Response to steroid therapy
 The initial response to cortico-
steroids is a guide to prognosis.
(1) Total effect
(2) Partial effect
(3) Non-effect
3. Pathologic type (P328)
Minimal change
disease(MCD). MCD: 80% of
patients.
1.Proteinuria: Fundamental
 2.Hypoproteinemia (mainly
albumin)
3.Edema: Nephrotic edema
(pitting edema)
 Hypoproteinemia plasma
oncotic
pressure is diminished, result
in a shift of fluid from the
vascular to the interstitial
compartment and plasma
volume↓→the activation of

the renin–angiotensin–
aldo-
sterone system→ tubular
sodium chloride reabsorp-
tion↑.
 4. Hyperlipidemia (Hyper-
cholesterolemia)
Ch↑, TG↑, LDL-ch↑,
VLDL-ch↑.
 Clinical Manifestations
There is a male preponderance
of 2:1.
1.Main manifestations: Edema
(varying degrees) is the common
symptom.
 Periorbital swelling and
perhaps oliguria are noticed
→→increasing edema→→
anasarca evident.
 2.General symptoms:

Pallid, anorexia,
fatigue,
abdominal pain, diarrhea.
Treatment
1.General measures
1.1 Rest
 1.2 Diet
Hypertension and edema:
Low salt diet (<2gNa/ day) or
salt-free diet.
Severe edema: Restricting
fluid intake.
 Increase proteins properly:
2g/(kg·day)
While undergoing the corti-
costeroid treatment: Give VitD
500~1000iu/day (or Rocaltrol)
and calcium.
1.3 Prevent infection
1.4 Diuretics
Not requires diuretics usually.
＊ HCT 2~5mg/(kg · day)
＊ Antisterone 3~5mg/(kg · day)
＊ Triamterene
 Attention: Volume depletion,
disorder of electrolyte and
embolism.
 2.Corticosteroid therapy
Short-course therapy:
Prednisone 2mg/(kg·day) or
60mg/m /day (Max.60mg/day)
2

in 3 or 4 divided doses for 4wk

→maintenance treatment:
 Prednisone 1.5mg/kg, single
dose for every-other day×4wk.

▲Total course of therapy: 8

wk.
 Middle-course & long-course
therapy:
① Induction of remission:
Prednisone 1.5~2mg/(kg · day)
(Max.60mg/day) for 4wk until
the urinary protein falls to
trace or negative levels ②
②After maintenance
treatment:
Prednisone 2mg/kg , single
dose for every-other-day×4wk
tapered gradually (2.5~5
mg/2wk) discontinued.
▲Total course of treatment :
★Middle: 6mo
★Long: 9~12mo
Estimate of curative effect
 3. Treatment of relapse and
recurrence
3.1 Extend the course of corti-
costeroid
3.2 Immunosuppressive agents
(Cytotoxic agents):
 ① CTX (Cytoxan)
2mg/(kg·day) for 8~12wk .
Total amount: 250mg/kg

Side effects: nausea, vomiting,

WBC↓, trichomadesis, hemo-
rrhagic cystitis and the damage
② CB (Chlorambucil)
0.2mg/kg for 8wk .
Total amount : 10mg/kg
③ VCR & Levamisole
 4.Impulsive therapy
(1) Methylprednisolone (MP)
15~30mg/kg(<1g/day+10%
GS 100~ 250ml, iv drip (within
1~2hr) , 3 times/one course. If
necessary, give another 1~2
courses after 1~2wk
prednisone 2mg/kg, qod
tapered gradually.
 (2) CTX
0.5~0.75mg/m2 + NS/GS iv
drip (1hr), give liquid 2,000ml
/(m .d) .
2

Every one mo for 6~8 times.

 (3) CsA
5~7mg/kg, in 3 divided doses
for 3~6mo.
★expense and nephrotoxicity.
(4) Anticoagulants
Heparin
Persantin 5mg/(kg·day ） for
6mo.
 5.Alleviar proteinuria
Angiotensin converting en-
zyme inhibitions (ACEI) :
Captopril, Enalapril and
Benazepril.
 Prognosis
Most cases of minimal
change disease eventually
remit permanently.