CLINICAL PRESENTATIONS OF NEPHROTIC SYNDROME IN PATIENTS OF A TERTIARY CARE HOSPITAL AT PESHAWAR

Najam -ud- Din, Ahmad Zeb Khan, Syed Javed Hussain Shah, Nisar Anwar, Fuad Hakeem

Abstract


Background: Nephrotic syndrome (NS) is manifested by presence of pitting oedema, profound proteinuria in excess of 3.5 g/day, serum albumin levels of less than 3.0 g/dL and hypercholesterolemia. This study was conducted to determine the frequency and clinical presentation of nephrotic syndrome in patients coming to a tertiary care hospital. Methods: This cross-sectional study was done from March to November, 2012 (for 9 months). Patients with complaints of peri-orbital or generalized swelling, and proteinuria on urine examination were included in the study through emergency or out-patient department. Results: Out of 360 suspected cases, nephrotic syndrome was found with a frequency of 67.05%. Among these patients, 69.55% were male and 30.45% female. Majority (65.85%) were between 41–60 years with mean age of 40.36±15.93 years. All (100%) patients had oedema, 43.20% had oliguria, 17.28% presented with abdominal tenderness, 15.22% patients had fever, 13.16% showed hematuria, 10.28% patients had uraemia and 2.5% of the patients had thrombosis. The majority of patients (56.80%) were diabetic, and 43.20% patients had hypertension. In 23.86% patient’s high blood urea alone was recorded and 17.28% showed high serum creatinine along with raised blood urea. Rest of patients had normal renal function at the time of presentation. Conclusion: Frequency of nephrotic syndrome was 67.05%. Among these majorities were males. Oedema was the commonest presenting complaint while oliguria, abdominal tenderness, fever, hematuria, uraemia and thrombosis were found in descending orders. Diabetes mellitus was leading cause in majority of patients, followed by hypertension, high blood urea, and high serum creatinine.

Keyword: Nephrotic syndrome; presenting features; diabetes mellitus; hypertension

Full Text:

PDF

References


Matsumoto H, Miyaoka Y, Okada T, Nagaoka Y, Wada T, Gondo A, et al. Ratio of urinary potassium to urinary sodium and the potassium and edema status in nephrotic syndrome. Intern Med 2011;50:551–5.

Abbas K, Mubarak M, Kazi JI, Muzaffar R. Pattern of morphology in renal biopsies of nephrotic syndrome patients. Correlation with immunoglobulin and complement deposition and serology. J Pak Med Assoc 2009;59:540–3.

de Seigneux S, Martin PY. Management of patients with nephrotic syndrome. Swiss Med Wkly 2009;139:416–22.

Cohen EP, Sujeet K, Batuman V. Nephrotic syndrome. [Online] 2012 [Cited on 2012, December 12]. Available from URL://http://www.medisuite.ir/medscape/a244631-business.html

Hull RP, Goldsmith DJ. Nephrotic syndrome in adults. BMJ 2008;336:1185–9.

Burgstein JM. Nephrotic syndrome. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson textbook of pediatrics. 18th ed. Philadelphia: WB Saunders; 2008. p.2430–42.

Ali A, Ali MU, Akhtar SZ. Histological pattern of paediatric renal diseases in Northern Pakistan. J Pak Med Assoc 2011;61:653–8.

Akhtar SZ, Ali A. Histological pattern of nephrotic syndrome in elderly patients. J Ayub Med Coll Abbottabad 2008;20(4):97–9.

Keddis MT, Karnath BM. The nephrotic syndrome. Hosp Physician 2007;43(10):25–30,38.

Nadir SJ, Saleem N, Amin F, Mehmood KT. Steroid sensitive nephrotic syndrome in paediatrics. Pak J Pharm Sci 2011;24:207–10.

Ruggenenti P, Gaspari F, Perna A, Remuzzi G. Cross sectional longitudinal study of spot morning urine protein: creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes. BMJ 1998;316:504–9.

Huq N, Khatun H, Jinnah SA. Morphological pattern of glomerular diseases in adult nephrotic syndrome. Mymensingh Med J 2011;20:652–7.

Tao JL, Liu LL, Wen YB, Gao RT, Li H, Li MX, et al. Cyclosporine treatment in idiopathic membranous nephropathy nephrotic syndrome in adults: a retrospective study spanning 15 years. Chin Med J (Engl) 2011;124:3490–4.

Akoglu H, Agbaht K, Piskinpasa S, Falay MY, Dede F, Ozet G, et al. High frequency of aspirin resistance in patients with nephrotic syndrome. Nephrol Dial Transplant 2012;27:1460–6.

Resh M, Mahmoodi BK, Navis GJ, Veeger NJ, Lijfering WM. Statin use in patients with nephrotic syndrome is associated with a lower risk of venous thromboembolism. Thromb Res 2011;127:395–9.

Ghafari A, Mehdizadeh A, Alavi-Darazam I, Rahimi E, Kargar C, Sepehrvand N. Co-administration of albumin-furosemide in patients with the nephrotic syndrome. Saudi J Kidney Dis Transpl 2011;22:471–5

Azam M, Suleman H, Khan PA. Nephrotic syndrome. Professional Med J 2005;12(1):23–31.

Deshmukh S, Deshmukh S, Haneef I, Wong N. Structure of the renal system. In: Deshmukh SR, Wong NWK, editors. The renal system explained: an illustrated core text. Nottingham, UK: Nottingham University Press; 2009.p.43–78.

Thomas S, Viberti G. Diabetic nephropathy. Medicine 2006;34:83–6.

Khanna R. Clinical presentation & management of glomerular diseases: hematuria, nephritic & nephrotic syndrome. Mo Med 2011;108:33–6.

Ibadin MO, Abiodun PO. Epidemiology and clinicopathologic characteristics of childhood nephrotic syndrome in Benin-City, Nigeria. J Pak Med Assoc 1998;48:235–8.

Wang J, Fan Q, Chen Y, Dong X, Zhang Y, Feng J, et al. A case report of minimal change nephrotic syndrome complicated with portal, splenic and superior mesenteric vein thrombosis. Clin Nephrol 2012;77:505–9.

Kerlin BA, Ayoob R, Smoyer WE. Epidemiology and pathophysiology of nephrotic syndrome-associated thromboembolic disease. Clin J Am Soc Nephrol 2012;7:513–20.

Khan JA, Masood T, Shamsi F. Nephrotic syndrome: a rare cause of acute coronary syndrome in a child. J Coll Physicians Surg Pak 2012;22:123–5


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]