Nephrotic syndrome: causes, symptoms and treatment

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2018-10-24 06:00:50

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Nephrotic syndrome according to ICD (international classification of diseases) is not an independent kidney disease but a group of symptoms, the totality of which shows that the kidneys aren't working as well as they should.

The Small blood vessels (venules, arterioles and capillaries) in the kidney function as microfilters in removing toxins, end products of metabolism and excess water from the blood. These wastes and water get into the bladder and leave the body with urine. Normal urine should be protein.

Renal vessels are part of the glomerular network of the filtration system of the kidneys. When the filter network is damaged, too much protein passes through the filters in the urine. The consequence is nefroticski syndrome, i.e. the progressive destruction of the working tissue of the kidney (the nephrons).

This kidney disease affects both adults and children.

Signs of kidney disease

Most people diagnosed with this pathology, I did not know about it until when a routine medical examination were not in routine clinical studies.

the Signs of kidney disease

Symptoms of nevropatologii include:

  • Excessive urinary protein excretion (proteinuria).
  • Low protein content in the plasma. The medical record can be written: “hypoalbuminemia”.
  • High levels of cholesterol in the blood. Medical term hyperlipidemia.
  • High level of neutral fats in the blood called triglycerides.
  • Swelling of the face, hands, feet and ankles.
  • Weight gain.
  • Constant feeling of fatigue.
  • Foamy urine.
  • Reduced hunger.

If the results of the General tests you have identified a clinical nephrotic syndrome, your doctor will need to determine the cause of the problem. This may require additional tests and diagnostic procedures to discover the root cause.

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Kidney Disease often do not have clinical symptoms until the working tissue of the kidney is not severely damaged (70-80 %).

All the necessary proteins

There are many types of protein, our body uses proteins in a variety of ways, including the formation of bones, muscles and other tissues that make up organs, and infection control.

When kidney tissue is suffering, the kidneys cease to function normally, thereby allowing a protein called albumin to pass through your filtration system into the urine.

Albumin helps the body rid itself of excess fluid. With a lack of albumin in the blood, fluid accumulates in the body, causing swelling in the face and lower parts of the body.

Cholesterol as an important component of the human body

Our body requires cholesterol, which is produced in it yourself. In addition, cholesterol also enters the interior of the food. Excessive intake of cholesterol in the blood damages the vessels because droplets of this substance glued on the walls of the veins and arteries and can form clots (full or partial blockage of the vessel lumen). Clots in the blood vessels impede the functioning of the heart and blood flow to organs and tissues, which subsequently can result in a myocardial infarction or stroke.

Triglycerides - a kind of “energy” of fat in the blood

When we eat food, our body consumes the calories received from food for energy. If we eat more calories than expended, the excess calories are converted into triglycerides.

Triglycerides are stored in adipose tissue, when absolutely necessary, they are used as energy to maintain normal functioning of the cells. The presence of high triglycerides in the blood indicates a high predisposition to heart disease.

Who are prone to nephritic syndrome?

Symptoms of nephrotic syndrome

People of all ages, sexes and ethnic groups can be prone to this disease, but, according to the Ministry of health (minsa), is more common in men than in women.

Nephrotic syndrome in children usually occurs from age 2 to 6 years.

Certain factors increase the likelihood of progressing kidney disease include:

  • Nevropatologii (glomerulonephritis, nephrolithiasis, etc.).
  • Urolithiasis - urolithiasis.
  • Long-term use of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics.
  • Infection: HIV, viral hepatitis, malaria.
  • Diabetes, lupus and amyloidosis.

The Etiological factors (causes)

The Syndrome can be caused by various kidney diseases, and other factors.

If the disease affects only the kidney, they are called primary causes of nephrotic syndrome. Other factors that affect the whole body, including the kidneys are called secondary causes.

Most people suffer from progressive renal disease due to secondary causes.

Nephritic syndrome

The Most common primary cause in adults is a disease called focal segmental glomerulosclerosis (FSGS). FSGS causes scarring on a microscopicthe filters of the kidneys called glomeruli.

Some autoimmune diseases and chronic diseases of the immune system can severely damage the kidneys.

Amyloidosis is a genetically mediated disease in which there is an accumulation of protein material called amyloid in the blood. It is postponed on walls of vessels, in various organs, including the kidneys.

The Most common secondary factor in adults is diabetes. Pathology is accompanied by disease of the kidneys, known as renal (kidney) diabetes.

The Most common primary factor renal syndrome in children is minimal change disease (BME). The disease with minimal changes causes hidden damage to the kidneys, which can be detected only through a very powerful microscope.

The Most common secondary factor in children is diabetes.

In all forms distinctive unifying feature of the disease is progressive destruction of the glomeruli.

Kidney that affect the tubules and interstitium, such as interstitial nephritis, do not cause nephrotic syndrome.

Diagnostic capabilities

  1. Blood test for determination of glomerular filtration rate of kidney (eGFR, Estimated Glomerular Filtration) is a rapid test for assessing the functional ability of the kidneys. Your eGFR is a number, based on the analysis of creatinine and urea in blood serum. Primary urine is formed by filtration of blood plasma through the glomerular barrier; in humans the glomerular filtration rate (GFR) is 125 ml/min.
  2. Clinical examination of urine. When severe damage to the kidneys large amounts of protein passes into the urine. This may be one of the earliest signs of nephrotic syndrome kidney. To check for protein in the urine (called proteinuria), must pass urinalysis with microscopy of sediment. Physiological significance of plasma albumin is 0.1 %, which normally can pass through the glomerular filtration barrier.
  3. Ultrasound of the kidneys and urinary bladder for diagnosis of nephrotic syndrome. Will allow to evaluate the morphological (structural) condition of the kidneys and blood circulation. Ultrasound will also help identify concomitant pathology of the urinary system.
Diagnosis of nephrotic syndrome

Suspecting kidney disease can after Express-analysis of urine with a test strip. With a high reference value of proteinuria indicator strip will change its color.

The Clinical study of blood indicating a low level of serum protein, called albumin, which will confirm the diagnosis.

In some cases, when the prescribed treatment is ineffective, will be assigned to a kidney biopsy. For this very small sample of the kidney tissue removed with a needle and examined under a microscope.

Renal proteinuria is the loss of three or more grams of protein a day, through urine, or after a single collection of urine, the presence of 2 g of protein per gram of urine creatinine.

For nephrotic syndrome is characterized by the combination of nephrotic range proteinuria with hypoalbuminemia serum and swelling in the facial space and the lower parts of the body.

Complicating factors of renal syndrome

Proteins perform many different functions. With a low level of serum (blood) protein and the body becomes prone to problems with blood clotting and the emergence of infections (given that the protein fraction of the blood composed of immunoglobulins are the main immune cells).

The Most frequent bacterial and viral complications are acute sepsis, pneumonia and peritonitis.

Venous thrombosis and pulmonary embolism (PE) are widely recognized consequences of acute nephrotic syndrome.

Other complications include:

  • Anemia (anemia).
  • Cardiomyopathy, including ischemia.
  • High blood pressure systemic hypertension.
  • Chronic swelling.
  • Acute and chronic renal failure (ARF, CRF).

Therapeutic kidney disease

There is No specific treatment of nephrotic syndrome, the medications usually are only symptomatic (cropped symptoms and complications) and preventive (prevent further destruction of renal tissue).

It is Important to know that the complete kidney failure (end-stage renal failure) require dialysis and future kidney transplant to preserve life.

Treatment of nephrotic syndrome

Physician prescribes medicine to relieve certain symptoms. This can be a medication to control hypertension and cholesterol to reduce the risks of cardiovascular diseases.

Drugs for reducing hypertension, called ACE inhibitors (angiotensin converting enzyme) and ARBS (blockers of angiotensin II receptors), which reduce the pressure in the capillaries and prevent the release of protein into the urine.

Diuretics are assigned in order to help the body get rid of excess water, as well as to control blood pressure and reduce swelling.

Troversial medications (anticoagulants) are recommended in cases the risk of blood clots to prevent a heart attack (myocardial infarction) anda stroke.

A Very important role in treatment plays a change in diet; diet low in fat helps to control cholesterol levels in the blood. Choose fish or meat skim.

Limit your intake of salt (sodium chloride) to reduce edema formation and to maintain blood pressure at a healthy level.

Immunosuppressive medications suppress excessive response of the immune system in glomerulonephritis and systemic lupus such as corticosteroids ("Prednisolone", "Decortin", "Medopred", etc.).

How to prevent progressive destruction of the kidneys?

The Only way to prevent this syndrome is to prevent diseases that can cause it.

Prevention of nephrotic syndrome

The presence of disease that can harm the kidneys, consult with your doctor to develop clinical guidelines for nephrotic syndrome, to control their underlying disease and prevention of kidney injury.

Discuss with your doctor the possibility of specific tests to determine the functional ability of the kidneys.

It is very important for people with diabetes, high blood pressure or a family history of kidney disease. Kidney damage is always irreversible, the cells after death not restored. But if you have identified the underlying disease at an early stage and assigned timely treatment, there is a chance to prevent deterioration.

Renal Pathology in children

Although nephrotic syndrome can affect people of any age, it usually first diagnosed in children aged 2 to 5 years.

The Pathology affects more boys than girls. Every year about 50 000 children diagnosed with glomerulonephritis with nephrotic syndrome. As a rule, it is more common in families with a history of renal or autoimmune diseases, or in the Asian Diaspora, although it is unclear why.

Nephrotic syndrome in children

The Symptoms of kidney disease in children

As well as in adults, edema is first visible around the eyes, then in the lower parts of the legs and other parts of the body.

Immunoglobulins - antibodies, which are a specialized group of proteins in the blood that fight infections. When the body loses protein, children have a much higher chance of Contracting an infectious disease.

There are changes in urine - sometimes a high level of protein entering the urine, leads to the fact that it becomes frothy.

The Majority of children with nephrotic syndrome have “the disease with minimal change”. This means that their kidney tests appear normal or almost normal, as long as the tissue sample obtained by biopsy, not examined under a microscope. The cause of the disease with minimal change is unknown.

With a hereditary nephrotic syndrome of the Finnish type, the gene for Nerina, a protein of the filtration slit, is mutated, leading to kidney disease in infancy.

He Also occurs as a result of kidney problems or other conditions, for example:

  • Glomerulosclerosis - when the internal structure of the kidney becomes damaged.
  • Glomerulonephritis - inflammation in the filtration system of the kidney;
  • Infection - e.g. HIV or hepatitis b and C;
  • Systemic lupus erythematosus;
  • Diabetes;
  • Sickle cell disease;
  • In very rare cases, some types of cancer - such as leukemia, multiple myeloma or lymphoma.

But these problems are more common in adults than in children.

Symptoms of nephrotic syndrome in children can be controlled with the help of steroid drugs.

The Majority of children respond well to steroids, and the risk of kidney failure is minimized. However, a small number of children have (inherited) congenital nephrotic syndrome, and it usually worse amenable to therapy. Ultimately, the syndrome in end stage chronic kidney disease, and these children require kidney transplant.

Most children positively responding to therapy, the symptoms take control, there comes a remission is a temporary suspension of the development of the disease, then after some time the symptoms return again - a recurrence.

In most cases, relapses become less frequent as children get older, nephrotic syndrome often stops them in adolescence.

Pathological state

Parents need to treat the baby to a specialist (pediatric nephrologist) for further guidance on nephrotic syndrome, the tests and special treatment.

The Main treatment is steroids (GCS - glucocorticosteroids), but additional treatments can also be used if the child develops significant side effects.

Most of the children relapses occur until late adolescence, and during these periods they need to take steroids.

Children with congenital nephrotic syndrome is usually administered at least 4 weeks course of "Prednisone" and then reduced the dose a day for another four weeks. This prevents the proteinuria.

When "Prednisone" is assigned for short periods of time, usually no serious or long-term sideeffects, although some children experience:

  • Increased appetite;
  • Weight gain;
  • Flushing;
  • Frequent mood swings

The Majority of children respond well to treatment of nephrotic syndrome "Prednisone", and often the protein disappears from the urine and swelling disappear within a few weeks. During this period, there comes a remission.

Diuretics, or diuretics, can also be used to reduce fluid accumulation. They work by increasing the amount of urine produced.

Penicillin is an antibiotic, and can be assigned during relapses, to reduce the likelihood of infection.

It is Important diet. It is necessary to reduce the amount of salt in your child's diet to prevent further water retention in the body and formation of edema.

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