Principle Management of Nephrotic Syndrome

1) Confirm Diagnosis
    - Fulfill the criteria: 
        > 1g/m²/day urine protein, Albumin < 25g/L, Gen Edema
    - Exclude secondary causes ---> 
        Infection (Hep B, HIV. Malaria), Malignancy (Lymphoma, Leukemia), CTD (SLE)


2) General Measures
    - Control Edema --->
       Normal protein & less salt diet, +/- Frusemide with caution  (ROF in Chronic Edema) 
    - Asses Hemodynamic (Hypo/Hypervolemia) --->
       Daily Nephrotic Chart & I/O Chart
    - Penicillin V Prophylaxis ---> Dose according to age

3) General Advice
    - Nature of disease -->
       Most will relaspe (85%-95%) - Consult Dr if Pro 2+ in 3 conseq days/ edema+
       Mostly idiopathic, Not affect renal fx
    - Home dipstick monitoring --> Once daily at early morning 
    - Tx option & its Cx -->
       Long Term Steroid, Cushing's, Immunocompromised (avoid infectious contact)
    - Immunization : Pneumococcal Vaccine -->
       Give during remission

4) Specific Tx for Primary Nephrotic Syndrome 
    - Long Term Corticosteroid or
    - Cyclophosphamide --> For frequent relapse/ Steroid dependent 
    - Steroid Resistant --> Renal biopsy (specific Tx depend on HPE) + supportive 

5) Manage Cx of Nephrotic Syndrome/ Cx of the Tx (if any)
    - Hypovolemia --> Tx: Human Albumin fast infusion
    - Spont Bacterial Peritonitis --> Tx: IV C. Pen + 3rd Gen Cephalosporin
    - Thrombosis --> Prophylaxis

    - Cushing's Syndrome --> Tx: Taper down steroid/ change to Cyclophosphamide 
    - Immunocompromised --> 
       Immunization, avoid infectious contact, fever come to hospital
    - Acute Adrenal Crisis --> when udergone stress TX : HCT/ Prednisolone 
    - Loosing protein --> Muscle Wasting Tx: advice on diet (high calorie)