Nephrotic Syndrome: Symptoms and Treatment


Nephrotic syndrome is a disorder of the functioning of the kidneys, characterized by a strong loss of protein, which is excreted from the body along with urine, a decrease in albumin in the blood and impaired metabolism of proteins and fats. The disease is accompanied by edema with localization throughout the body and increased blood clotting ability. Diagnosis is made on the basis of data on changes in blood and urine tests. The treatment is complex and consists of a diet and drug therapy.

The disease can occur at any age, but nephrotic syndrome occurs most often in children from one to four years of age, mostly in boys more often than in girls, and in adults up to the age of forty. The pathogenesis of the disease consists in the fact that a large number of proteins and lipids accumulate in a person’s urine, which seep into the cells of the skin, resulting in a symptom such as edema, characteristic of both acute and chronic forms of the disease. Without proper treatment, the disease can lead to complications that are dangerous to human health and life.

Etiology

The causes of the onset of the disease are not fully understood, but it is known that they can be primary and secondary. The primary sources include:


  • hereditary predisposition
  • congenital abnormalities in the structure and functioning of the kidneys
  • diseases of the urinary system, and kidneys in particular. These include pyelonephritis, amyloidosis, nephropathy in pregnant women, etc.

Secondary reasons are:


  1. viral infectious diseases occurring in the body, including AIDS and hepatitis
  2. diabetes;
  3. pre-eclampsia or a complicated form of it — eclampsia
  4. blood poisoning
  5. Tuberculosis
  6. chronic endocarditis;
  7. abuse of certain drugs that affect kidney or liver function
  8. various allergic reactions;
  9. heart failure of a chronic nature
  10. poisoning the body with chemical compounds
  11. autoimmune diseases
  12. Lupus;
  13. Oncological neoplasms in the kidneys.

In some cases, but most often in children, it is rather difficult to determine the cause of the illness, but it is associated with the weak immunity of the child and a high susceptibility to a wide range of diseases. The pathogenesis of the disease directly depends on the etiological factors.

Species

As mentioned above, nephrotic syndrome can be classified into:


  • Primary — caused by various renal diseases. He, in turn, can be hereditary or acquired. If everything is clear with the first kind, it is inherited from the next of kin, then in the second form, a person is born healthy, but during a lifetime he develops various kidney diseases, which causes the appearance of a nephrotic syndrome;
  • secondary — in which the disease is formed against the background of other inflammatory processes of the body
  • idiopathic — the reasons for which it is extremely difficult or impossible to establish. This type is very common in children.

There are several types of nephrotic syndrome that are classified according to how much they respond to hormone treatment:


  1. hormone sensitive — well treatable
  2. insensitive to hormones — in this case, other drugs are used to suppress the intensity of the pathological process.

Classification by volume of blood that circulates through the vessels:


  • hypervolemic type — volume increased;
  • hypovolemic — a significant decrease in blood volume.

By the degree of manifestation of symptoms:


  1. acute nephrotic syndrome — signs are expressed once,
  2. chronic — pathogenesis manifests itself with periods of remission and exacerbation. Often appears in adults, due to improper or incomplete treatment in childhood.

Symptoms

Edema in nephrotic syndrome is the main symptom of the disease. At the first stage appear on the face, in particular on the eyelids, further spread to the genitals and lower back. After that, the exudate accumulates in the abdominal cavity, the free space between the ribs and the lungs, the pericardium, and also often throughout the subcutaneous tissue. Other signs of nephrotic syndrome include:


  • general weakness of the body
  • feeling dry in the mouth, despite thirst;
  • severe headaches and dizziness;
  • heaviness in the lower back;
  • nausea and vomiting
  • diarrhea;
  • tachycardia
  • Disruption of urine output. The daily volume drops to one liter. Seldom, but there may be an admixture of blood;
  • increased abdominal volume
  • decreased appetite
  • the appearance of dyspnea not only during movement, but also at rest
  • the skin takes a pale shade and becomes dry, why it flakes off;
  • seizures;
  • fragility and hair loss
  • Stratification of nail plates.

If the nephrotic syndrome has passed into a chronic form, the symptoms will be less pronounced, whereas in the acute — manifest more.

Complications

The untimely or inadequate treatment of nephrotic syndrome in children and adults can lead to the following consequences:


  1. infections that attack specially weakened, for the time of treatment of the main ailment, immunity. This is due to the fact that during the therapy avoid unwanted protective reactions of immunity (prescribe special drugs)
  2. nephrotic crisis — in which the proteins in the body fall to a critical value, and blood pressure rises. In some cases, it causes death of the patient;
  3. edema of the brain — occurs due to fluid accumulation and increased pressure in the intracranial box
  4. pulmonary edema
  5. a heart attack characterized by the dying of the heart tissue
  6. the formation of blood clots in the arteries of the lung;
  7. Vascular thrombosis, which becomes the impetus for blood circulation disorders
  8. Atherosclerosis — in which insufficient blood is supplied to the internal organs
  9. Increased blood’s ability to coagulate, resulting in proper thrombi formation
  10. Anorexia

If the nephrotic syndrome is diagnosed in a pregnant woman, it will be fraught with additional complications for her and the newborn:


  • gestosis, i.e., complicated by the course of pregnancy. The patient develops eclampsia with pronounced symptoms, which can lead to the death of the baby and the comatose state of the mother;
  • a manifestation of congenital nephrotic syndrome in a baby
  • Forced abortion;
  • premature birth.

Complications from the disease can occur not only in chronic course, but also when acute.

Diagnostics

Differential diagnosis of nephrotic syndrome consists of a set of measures:


  1. collecting information about the disease — is carried out to determine the chronic or acute leakage
  2. conducting an examination of the patient
  3. laboratory tests
  4. A hardware examination of the patient.

When collecting a complete history of an ailment, its pathogenesis, the degree of symptom intensity and the time of their occurrence, whether there were cases of detection of a similar disease in relatives, whether the patient was treated, on what it was based and by what methods was carried out.





Diagnosis is carried out by a urologist. When examining a patient, he determines the general condition of the patient, examines the skin and palpation of edema, which are characterized by some features:


  • skin in place of edema of pale color;
  • soft in density;
  • the location of the site depends on the stage of the disorder;
  • the most intense in the daytime, and fall toward the evening.

Blood and urine tests of the patient undergo laboratory diagnosis, during which general and biochemical studies are conducted. The nephrotic syndrome is characterized by the detection of proteins in the urine, and in the blood a decreased or elevated level of proteins, albumin, cholesterol. The ability of the kidneys to filter is also determined. The analysis of urine is carried out according to Nechiporenko and Zimnitsky’s trial.

In order for blood and urine to show reliable results, it is best to take the test in the morning, on an empty stomach, after giving up alcohol and tobacco smoking. Blood is taken from the ulnar vein, and urine is collected immediately after a night’s sleep.

The hardware examination of the patient is:


  1. kidney biopsy, during which a small portion of the organ tissues for testing are sampled;
  2. Kidney ultrasound is used to determine the presence of malignant neoplasms — cysts or oncological tumors in this organ
  3. Contrast scintigraphy. The ability of the kidneys to filter the introduced substance is determined;
  4. EGC — determines the heart rate, the nephrotic syndrome is characterized by a decrease;
  5. Radiography of the lungs can detect fluid accumulation in this area and the presence of blood clots.

After receiving all diagnostic results, the specialist prescribes treatment. It is also important to conduct a full differential diagnosis, to exclude similar pathologies and to prescribe the right treatment.

Treatment

Nephrotic syndrome therapy, similar to diagnosis, is not limited to a single remedy. The patient is assigned:


  • Glucocorticosteroid preparations — they help reduce puffiness, have anti-inflammatory and anti-allergic properties
  • cytostatic substances — prevent the increase in the number of pathological cells
  • Immunosuppressants — are prescribed for artificial lowering of immunity, which is considered normal for the treatment of this disorder
  • Diuretics are an excellent way to relieve swelling
  • the introduction into the blood of special solutions of a certain volume and concentration, which are calculated for each person individually. Among them, albumin, plasma-substituting substance and plasma proper, only in fresh-frozen form
  • Antibiotics, with different dosages for children and adults.

In some cases, the patient may need to be hospitalized, it is necessary: ​​


  1. to determine the underlying disease that caused the syndrome;
  2. if respiratory function is impaired
  3. for the treatment of complications.

In addition, patients are assigned a diet, but only with certain indicators of differential diagnosis:


  • pronounced edema;
  • depending on protein content in urine
  • the ability of the kidneys to filter.

The diet consists in the normalization of metabolism and prevention of edema. This method of treatment is:


  1. consuming no more than three thousand calories a day
  2. meals should be taken in small portions six times a day;
  3. the exclusion of fried and spicy foods
  4. Limiting salt. Reduce its addition to food (no more than four grams per day)
  5. Enriching food with protein, carbohydrates and potassium
  6. reducing the intake of liquid to one liter.

Products that can be consumed in any quantities during a diet:


  • bran bread
  • lean fish and meat cooked steamed or baked in the oven
  • dairy and sour-milk products, but only with a low percentage of fat content
  • porridge and pasta
  • oil;
  • vegetables and fruits, in any form, except fried
  • compotes, fresh herbs, morsels, herbal and berry teas
  • jam, sugar and honey

During a diet, it is worth noting:


  1. bakery products that were prepared with the addition of salt
  2. greasy and fried foods
  3. hard cheeses and fatty dairy products
  4. margarine;
  5. Legumes
  6. confectionery products
  7. raznosolov;
  8. onion and garlic;
  9. hot sauces and condiments;
  10. sweet carbonated drinks
  11. strong tea and coffee.

Prevention

Preventive measures for nephrotic syndrome are:


  • timely diagnosis of a congenital ailment, especially before a woman decided to become pregnant;
  • full treatment and prevention of infections
  • early treatment of kidney disease;
  • maintaining a healthy lifestyle
  • rationalization of nutrition. It is necessary to enrich the food with proteins and potassium, and also observe the diet presented above;
  • Prophylactic examinations for doctors several times a year.