Nephrotic syndrome is a complex of pathological changes, against the background of which there is a loss of protein in the urine, swelling and a high concentration of lipids in the blood. Nephrotic syndrome is not a separate disease, but is a set of these symptoms that develop in different kidney diseases. In some cases, this syndrome is caused by systemic diseases, such as diabetes mellitus, amyloidosis or systemic lupus erythematosus. In this case, we speak of a secondary form of pathology.
Causes of nephrotic syndrome
Primary, or idiopathic, nephrotic syndrome develops against the background of kidney disease. According to the literature, about 80% of cases are due to acute or chronic glomerulonephritis, an inflammatory lesion of the structural units of the renal parenchyma, mainly renal tubules. The remaining 20% are congenital disorders and renal amyloidosis.
Secondary nephrotic syndrome is a sign of a general disease of the body, in which one of the symptoms is kidney damage.
Such pathologic conditions include:
- Metabolic diseases, diabetes mellitus, gout.
- Acute and chronic infections, leptospirosis, tuberculosis, sepsis, syphilis, malaria.
- Connective tissue diseases, systemic lupus erythematosus, dermatomyositis, scleroderma, rheumatoid polyarthritis.
- Myeloma disease and lymphogranulomatosis, hemorrhagic vasculitis.
- Poisoning food, heavy metal salts, insect and reptile venom.
- Allergic reactions, the effects of certain drugs.
Nephrotic syndrome can occur during pregnancy, the use of chemotherapy, against the background of cancer, with thrombosis of the renal vessels and inferior vena cava.
Symptoms of nephrotic syndrome
The main manifestation is edema. They come in different intensities: from minimal to accumulation of fluid in serous cavities.
Depending on the intensity of the pathological process, edema can progress slowly, and can be formed within a day.
Subcutaneous edemas form a dimple when pressed, while hydrocele of serous cavities leads to severe consequences:
- ascites, fluid in the abdomen, digestive disorders;
- hydrothorax, fluid in the chest cavity, shortness of breath, difficulty breathing;
- hydropericardium, fluid around the heart, weakness of the heart.
In addition to edema, signs of nephrotic syndrome include:
- instability of blood pressure;
- marked weakness and drowsiness;
- decreased appetite and liquid stools;
- pallor and dry skin.
Acute nephrotic syndrome is characterized by a rapid increase in clinical manifestations and an equally rapid decrease in symptoms. Depending on the cause, it may lead to acute renal failure and the development of chronic kidney disease, or it may end in complete recovery.
Complications of nephrotic syndrome
Complications are caused by protein loss, violation of water-electrolyte ratios, and decreased immunity. Worsen the course of the joined:
- Anemia resulting from a decrease in the iron-carrying protein transferrin in the blood.
- Inflammation of a bacterial, viral or fungal nature. Foci can occur anywhere and lead to deterioration of health and condition.
- Thrombosis, thromboembolism, associated with a violation of the blood clotting system, blood clotting, slowing blood flow.
- Renal failure, in which the blood retains poisonous products of metabolism, adversely affecting primarily brain cells.
- Increased blood pressure, which in itself is a bad prognostic sign and can lead to cerebral edema and blood supply disorders of the retina.
It is possible to develop a nephrotic crisis associated with a decrease in circulating blood volume, dehydration and shock. It is characterized by a sharp deterioration of well-being, a drop in blood pressure, abdominal pain and vomiting. There may also be fever and red spots on the skin.
Diagnosis of nephrotic syndrome
A set of diagnostic measures includes:
- general blood count (special attention to white blood cell counts), hemoglobin and platelets, hematocrit, the increase of which occurs with dehydration;
- blood chemistry with the determination of urea, creatinine, potassium as indicators of kidney function and total protein, as well as albumin;
- general urinalysis (increased attention to specific gravity and protein concentration);
- determination of the daily amount of excreted protein (for this purpose, analyze daily urine for protein concentration);
- ultrasound of the kidneys to detect possible changes in the structure of the organ.
Other diagnostic measures are performed as indicated and according to clinical guidelines for nephrotic syndrome.
Treatment
The basis of effective treatment is the identification and elimination of the cause. This is the most successful way of therapy for nephrotic syndrome. Elimination of the etiological factor can lead to the reverse development of the pathological condition. When this is not possible, pathogenetic and symptomatic therapy is applied.
Treatment is carried out as follows:
- Determination of the movement regimen, which should not be limited. Taking into account the condition and well-being of the treatment includes therapeutic physical training and walking.
- Salt-free diet: the amount of salt is limited even with normal kidney function, and in disorders and malfunctions reduced to 1-2 g per day. The diet should be limited to animal proteins, but with sufficient vegetable proteins. High concentration of protein in food leads to increased proteinuria (excretion of protein with urine). The amount of fluid should roughly match the amount of urine excreted.
- Medications are used to reduce the symptoms of the disease and swelling, preventing the development of possible complications.
- The use of corticosteroids, cytostatics that affect the immune mechanisms.
- Other drugs that have an antiproteinuric effect. These include nonsteroidal anti-inflammatory drugs.
Treatment success and prognosis depend on the cause of nephrotic syndrome and the timeliness of treatment initiated.
Conclusion
Nephrotic syndrome is a serious pathological condition that requires timely diagnosis and comprehensive treatment. It is important to establish the underlying cause of the disease, since the elimination of the etiologic factor significantly improves the prognosis. If etiotropic treatment is not possible, pathogenetic and symptomatic therapy is used, aimed at reducing the manifestations of the disease and preventing complications.
Compliance with therapeutic diet, control of fluid and salt intake, the use of medications aimed at reducing edema and stabilizing kidney function, play a key role in treatment. In some cases, the use of corticosteroids and immunosuppressants is required.
The prognosis of the disease depends on its cause, the degree of kidney damage and the timeliness of the initial treatment. With properly selected therapy and compliance with medical recommendations, it is possible to achieve a stable remission and preserve the quality of life of the patient.
