In this article, Niketrainers.com.co will tell you:
What is it and what are the causes?
Nephrotic syndrome is a group of clinical signs (symptoms) and laboratory abnormalities that complicate kidney disease where there is a large loss of protein in the urine (proteinuria).
Nephrotic syndrome includes the following disorders:
- high proteinuria as the cause of nephrotic syndrome (protein loss in the urine is over 3.5 g per day, and in severe cases, even several grams per day).
- swelling (See below)
- low level of protein in the blood (as it is lost in the urine)
- high levelof lipidsin the blood, mainly cholesterol
The causes of nephrotic syndrome are kidney diseases in which the structures of the glomeruli are damaged.
In children, submicroscopicglomerulonephritisis by far the most common cause.
In adults, the causes are more varied. In about 2/3 of the cases it is primary glomerulonephritis, and in 1/3 another disease, the complication of which is kidney damage (diabetes,systemic lupus erythematosus, amyloidosis).
Plasma proteins, primarilyalbumin, are filtered (like through a “hole-like sieve”) in the diseased glomeruli, which are then lost in the excreted urine. When the rate of protein loss by the kidneys is greater than the liver produces new proteins, their concentration in the blood decreases over time. Low levels of protein in the blood and sodium retention by diseased kidneys are causes of water retention in the body and the formation of swelling.
More common causes of nephrotic syndrome |
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Glomerulonephritis (KZN) |
submicroscopic KZNmembranous KZNfocal and segmental glomerulosclerosismesangial KZN (including IgA nephropathy) |
Damage to the glomeruli in the course of other diseases |
diabetic kidney diseasekidney amyloidosislupus nephropathycancers(lymphomas,multiple myeloma,cancer of the lung, breast, colon, stomach, kidney)reactions to drugs and nephrotoxic substances (non-steroidal anti-inflammatory drugs, gold, penicillamine, heroin)infections (hepatitis B or C, HIV)pre-eclampsia or eclampsiarenal vein thrombosis |
How common is nephrotic syndrome?
It is a relatively rare disorder, with one new case in 100,000 people a year. people.
How does nephrotic syndrome manifest?
The first symptom is usually swelling of the face (around the eyes) in the morning and swelling of the lower legs, increasing in size while standing, and most severely in the evening. Initially, they may be transient, i.e. intermittent. Sometimes they build up quickly and lead to a few kilos of weight gain in a matter of days.
In the most severe cases, in addition to swelling of the entire body, fluid accumulates in the abdominal cavity (ascites) and pleural cavities. The accompanying ailments include a lack of appetite and weakness. The consequence of kidney disease may bearterial hypertensionand symptoms of renal failure – acute or chronic.
Complications may include infections andvenousor arterial thrombosis (as urine also loses antibodies and proteins that regulate blood clotting). A common abnormality is also high blood cholesterol levels.
What to do in the event of symptoms?
The occurrence of edema is always a disturbing symptom and should prompt you to see a doctor immediately.
How does the doctor make a diagnosis?
The doctor diagnoses the nephrotic syndrome by the presence of swelling and abnormal urine tests (proteinuria usually> 300 mg / dL, protein loss in urine> 3.5 g per day) and blood (low levelsof total proteinand albumin, high levels of total cholesterol and LDL ). ).
The doctor then determines what kidney disease is causing the nephrotic syndrome. Information from the history, physical examination, and the results of laboratory and imaging tests performed may be sufficient to diagnose the cause of the nephrotic syndrome in diabetic kidney disease, amyloidosis and, often, nephropathy in the course of systemic lupus erythematosus. A kidney biopsy should be performed to determine the cause with confidence.
In the case of glomerulonephritis, the biopsy result allows you to determine its type, which is important for deciding on the treatment method.
What are the treatments?
The most important thing is to treat the underlying cause, which is the disease that causes damage to the glomeruli. In primary and many secondary glomerulonephritis, it is immunosuppressive treatment, most often with steroids.
Pharmacological treatment
If there are no contraindications, an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker (or both) is used as they reduce proteinuria and protect the kidneys.
Edema is treated with diuretics (sometimes high doses are necessary) so that the body weight is reduced by about 1 kg per day.
Diet
It is necessary to limit the salt in food to less than 6 g / day (6 g = 1 teaspoon). Cholesterol levels fall spontaneously as proteinuria decreases.However, if hypercholesterolaemiapersists , a cholesterol-lowering drug (statin) should be taken.
Treatment of thrombotic complications
In the event of thrombotic complications, anticoagulants are used – usually as long as the nephrotic syndrome persists (more about venous thromboembolism and its treatment – seeThrombosis).
Is it possible to recover completely?
Nephrotic syndrome is a consequence of large urinary protein loss and resolves when proteinuria is significantly reduced. Complete recovery is when the kidney disease is healed or resolves spontaneously, and this usually affects people with glomerulonephritis.
In some cases, healing is permanent, but in some people it may relapse over time. In cases such as diabetic kidney disease or amyloidosis, you can only count on improvement, not complete recovery.
What should I do after treatment is finished?
Long-term medical supervision is usually necessary in patients with chronic kidney disease. These people should be under the care of a nephrologist, who in each case decides at what intervals to report for inspection and what tests should be performed.
What to do to avoid getting sick?
Prevention of nephrotic syndrome is the prevention and treatment of kidney disease with high proteinuria. It is possible mainly in the case of diabetic kidney disease and chronic inflammatory diseases.