A 58-year-old male presents with pitting oedema of his ankles. He suffers from recently diagnosedhypertension, but is otherwise healthy. Blood results show low albumin and a urine dipstick is positive for protein. The most appropriate initial treatment is:
A. High protein diet
B. Diuretics
C. Prophylactic anti coagulation
D. ACE inhibitor
E. Bed rest
The answer is. B. Diuretics
This patient has the classic triad of proteinuria, low
serum albumin and oedema that occurs in the nephrotic syndrome. This can occur
due to a number of disease processes such as diabetes and SLE, as well as those
specific to the kidney, including minimal-change nephropathy and focal-
segmental glomeruloscierosis. First-line management should include dietary
measures to restrict sodium intake and a diuretic . Potental diuretics include
furosemide which is often required to control any associated severe oedema.
High protein diets do not have any benefit to the management of nephritic
syndrome, a normal low salt diet should be encouraged. Albumin infusion can be
used as adjuncts in patients who are resistant to diuretic therapy but never in
isolation as they have transient beneficial effects. Bed rest should also be
discouraged in patients since coagulation factors, for example antithrornbin,
are also lost as part of the proteinuria creating a hypercoagulable state,
patients are therefore at risk of thrornboembolism, including renal vein
thrombosis. Therefore, prophylactic anticoagulation is desirable to protect
against hypercoagulation and should always be considered,
Angiotensin-converling enzyme (ACE) inhibitors protect against proteinuria by
reducing the filtration pressure upon the glomerular capillaries.
