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By A. M. Davison (Auth.)

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3. A n o r e x i a a n d diarrhoea m a y well be d u e t o severe p r o t e i n mal­ nutrition. 4. Lethargy a n d tiredness are c o m m o n l y present. 5. Muscle wasting is p r o b a b l y d u e t o t h e cataboHsm of muscle p r o t e i n in an a t t e m p t t o maintain t h e n o r m a l plasma p r o t e i n c o n c e n t r a t i o n s . 6. Infections, particularly celluhtis, septicaemia, peritonitis a n d u r i n a r y tract infections, p r o b a b l y reflect t h e impaired cellular and h u m o r a l i m m u n i t y d u e to m a l n u t r i t i o n .

5. Calcium is low a n d even correction for t h e low plasma a l b u m i n frequently reveals a t r u e h y p o c a l c a e m i a . 6. ESR elevated. 7. Platelets usually elevated and frequently their adhesiveness is increased. NEPHROTIC SYNDROME 39 C o m p l i c a t i o n s of N e p h r o t i c S y n d r o m e . T h e r e are m a n y well recognized compUcations of t h e n e p h r o t i c s y n d r o m e a n d t o these can b e a d d e d t h e c o m p l i c a t i o n s of t h e r a p y w h i c h m a y b e used in p a t i e n t s w h o are n e p h r o t i c .

Infections Syphilis Q u a r t a n malaria S u b a c u t e bacterial e n d o c a r d i t i s Leprosy 4. Drug-induced Penicillamine Gold Mercury Phenindione Trimethadione Heroin a d d i c t i o n 5. Malignancy Carcinoma stomach C a r c i n o m a breast Choriocarcinoma Multiple m y e l o m a H o d g k i n ' s disease 6. Renal Vein Thrombosis 7. Congenital and Familial {see p. 53) Conditions M a n a g e m e n t T h e m a n a g e m e n t of t h e p a t i e n t should be aimed at: 1. S y m p t o m a t i c relief of o e d e m a .

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