Defined by proteinuria in excess of 3-3.5 g daily accompanied by hypoalbuminaemia, oedema, hyperlipidaemia and hypercoagulable state.

CAUSES

1. Primary Glomerular Disease

• Minimal Change Disease (MCD); - supposedly common in children, probably not the commonest in Ghana)

• Focal and Segmental Glomerulosclerosis (FSGS)

• Membranous nephropathy

• Membranous Proliferative Glomerulonephritis (MPGN)

2. Infections

• Viral - Hepatitis B and C, HIV, Infectious mononucleosis, Cytomegalovirus
• Bacterial (Post streptococcal infection)
• Parasitic (Plasmodium malariae malaria, Schistosoma mansoni, Filariasis)

3. Associated with Systemic Diseases

• Diabetes mellitus
• Systemic Lupus Erythematosus
• Amyloidosis
• Vasculitides

4. Drug Related

• Gold, Mercury
• Lithium
• Captopril
• Diamorphine (Heroin)

SYMPTOMS AND SIGNS

• Periorbital or peripheral oedema
• Pleural effusion
• Protein malnutrition particularly in children with long standing diseases
• Some 10% of adults with minimal change disease present with episodes of Acute Renal Failure

INVESTIGATIONS

• Urinalysis
• Plasma proteins
• Serum lipids
• Fasting blood glucose
• Serology - Hepatitis B, C, HIV

TREATMENT

Treatment Objectives

Management of the oedema

Non-Pharmacological Treatment

Low salt diet; adequate protein diet; 0.6-0.8 g/kg body weight of high class protein per day

Pharmacological Treatment

(Evidence rating: C)

Diuretic therapy includes:

• Furosemide (Frusemide), oral, 40 mg daily, increasing to 2 g daily in divided doses in adults or
• Bendrofluazide, oral, starting with 2.5 mg daily increasing to 5 mg once daily or
• Metolazone, oral, 2.5 mg to 20 mg once daily

REFER

All patients to a nephrologist or physician specialist