Nephrotic Syndrome

Definition

 Nephrotic syndrome is a nonspecific kidney disorder characterized by a number of signs of disease  :-

  • PROTEINURIA,
  • EDEMA.
  • HYPERLIPIDAEMIA  

Introduction:-

More than 26 million Americans-one in nine adults-have kidney disease. Millions more are at increased risk for getting it, and most don’t know it. Kidney disease can be found and treated early to prevent more serious kidney disease and other complications. Nephrotic syndrome is not a specific kidney disease. It can occur in any kidney disease that damages the filtering units in a certain way that allows them to leak protein into the urine by an increasing permeability of the capillary walls of the glomerulus.

Epidemiology:-

Nephrotic syndrome can affect any age, although it is mainly found in adults with a ratio of adults to children of 26 to 1. There is a male predominance in the occurrence of nephrotic syndrome.

Signs and symptoms:-

It is characterized by proteinuria (>3. 5g/day), auditory hallucinations,   hypoalbuminemia.

  • Hypo-natremia may  also occurs.

A few other characteristics seen in nephrotic syndrome are:—

  • The most common sign is excess fluid in the body due to the serum hypoalbuminemia. Sodium and water retention aggravates the edema. This may take several forms
  1. Puffiness around the eyes, characteristically in the morning.
  2. Pitting edema over the legs.
  3. Fluid in the pleural cavity causing plural effusion.
  4. Fluid in the peritoneal cavity causing ascitis .Generalized edema throughout the body known as anasarca
  • Dyspnea may be present due to plural effusion or due to diaphragmatic compression with ascites.
  • Some patients may notice foamy or frothy urine due to a lowering of the surface tension by the severe proteinuria.

INVESTIGATION:-

The test will involve 24-hour bedside urinary total protein estimation.  Urine samples are taken to diagnose people suspected of having nephrotic syndrome.

The presence of albumin in the urine can be detected with a dipstick test performed on a urine sample.

The urine sample is tested for proteinuria, urinary casts, comprehensive metabolic pattern  (CMP) will look hypoalbuminemia: albumin

A kidney biopsy may also be used as a more specific and invasive test method  Further investigations are indicated if the cause is not clear including analysis of auto  immune markers, or  ultrasound of the whole abdomen.

Two Simple Tests To Check for Kidney Disease:

Albuminuria-to-creatinine ratio (ACR):-

Glomerular filtration rate (GFR) :- It is an indication of how well your kidneys are working to remove wastes from your blood. GFR is calculated using the serum creatinine and other factors such as age and gender. In the early stages of kidney disease GFR may be normal. A GFR number of less than 60 is low and may mean that you have kidney disease..

Complications:-

  • Nephrotic syndrome can be associated with a series of complications
  • Pulmonary edema
  • Hypothyroidism
  • Microcytic hypo chromic anemia:- iron deficiency caused by the loss of ferittin
  • Protein malnutrition this occurs when the amount of protein that is lost in the urine is greater than that ingested,
  • Cushing’s Syndrome
  • Blood clots:- This increases your risk of developing a blood clot (thrombus) in your veins.
  • High blood cholesterol and elevated blood triglycerides.
  • High blood pressure.
  • Acute kidney failure. If your kidneys lose their ability to filter blood due to damage to the glomeruli, waste products may build up quickly in your blood. If this happens, you may need emergency dialysis
  • Chronic kidney failure. Nephrotic syndrome may cause your kidneys to gradually lose their function over time. If kidney function falls low enough, you may require dialysis or a kidney transplant.

Infections.

Treatment:-

The treatment of nephrotic syndrome can be symptomatic or can directly address the injuries caused to the kidney.

Symptomatic treatment

The objective of this treatment is to treat the imbalances brought about by the illness, edema, hypoalbuminemia, hyperlipidaemia, hypercoagulability and infectious complications.

  • Edema: a return to an unswollen state is the prime objective of this treatment of nephrotic syndrome.

1. Rest

2. Medical nutrition therapy: Not consume more than 1 g of protein/kg body weight/ day,,] as a greater amount could increase the degree of proteinuria and cause a negative nitrogen balance Medication: diuretic drugs (frusemide). In severe cases of edema the diuretics can be administered intravenous.It may be necessary to give a patient potassium or require a change in dietary habits if the diuretic drug causes hypokalaemia as a side effect.

  • Hypoalbuminemia: is treated using the medical nutrition therapy,. It includes a moderate intake of foods rich in animal proteins.
  • Hyperlipidaemia: it can be treated with medical nutrition therapy as the only treatment or combined with drug therapy. Avoid saturated fats such as butter, cheese, fried foods, fatty cuts of red meat, egg yolks, and poultry skin. Increase unsaturated fat intake, including olive oil, canola oil, peanut butter, avocadoes, fish and nuts. In cases of severe hyperlipidaemia that are unresponsive to nutrition therapy the use of hypolipidemic drugs.
  • Thrombophilia: low molecular weight heparin (LMWH) may be appropriate for use
  • Infectious complications: an appropriate course of antibacterial drugs can be taken according to the infectious agent.

Treatment of kidney damage

The treatment of kidney damage may reverse or delay the progression of the disease. Kidney damage is treated by prescribing drugs:

  • Corticosteroids:
  •  Prognosis

The prognosis for nephrotic syndrome under treatment is generally good although this depends on the underlying cause, the age of the patient and their response to treatment.

Poor patient response to steroid therapy may predict a poor outcome. Children who present with hematuria and hypertension are more likely to be steroid-resistant and have a poorer prognosis.

Patient Education
Pediatric nephrotic syndrome is a chronic illness characterized by relapses and remissions, which can extend throughout childhood. Information booklets should be given to the family. Parents support and psychological counseling may be helpful for some families.

Progression to renal failure will require preparation for dialysis and/or kidney transplantation. Similarly, adults with forms of nephrotic syndrome that cannot be cured may progress to renal failure and the need for dialysis or kidney transplantation.