In medicine, nephrotic syndrome is a summary of several symptoms. These occur in different diseases of the renal corpuscles.
What is nephrotic syndrome?
The four leading symptoms of nephronic syndrome are edema, proteinuria to a large degree, hyperlipoproteinemia, and hypoproteinemia. Proteinuria is protein excretion in the urine greater than 3.5 grams per day. Edema causes tissue swelling as water accumulates in the body. A decreased concentration of protein is understood as hypoproteinemia. Hyperlipoproteinemia describes an increase in cholesterol and lipoproteins. All these symptoms occur because the kidneys no longer filter the blood properly. The kidney is made up of a million small filtering units called glomeruli or renal corpuscles. However, the filter membrane is more permeable once a nephrotic syndrome exists. Therefore, the organism tries to compensate for the protein deficiency caused by a reduced breakdown and an increased production of fat.
Causes
The most common causes of nephrotic syndrome include chronic disease of the renal corpuscles and minimal-change glomerulonephritis, a disease of the renal corpuscles, but most commonly seen in children. About 15% of nephronic syndrome is caused by chronic disease of the kidney. In this so-called focal segmetal glomerulosclerosis, not all renal corpuscles are damaged compared to the other two diseases. Less common causes include progessive kidney disease, renal involvement in collagenoses and amyloidosis, renal vein congestion, renal damage from plasmacytoma, and complications that can occur with malaria.
Symptoms, complaints, and signs
Nephrotic syndrome is associated with some typical symptoms. First, the loss of protein is prominent. This is referred to as proteinuria. In this case, protein is excreted in the urine; clearly recognizable by strong foaming. A lack of protein can also be detected in the blood, which is called hypoproteinemia. In addition, blood lipid levels rise. This in turn increases the risk of heart attack and coronary heart disease. In addition, patients often suffer from high blood pressure. Since the organism also loses antibodies due to impaired kidney function, infections occur more frequently. In addition, water accumulates in the abdomen (ascites) and edema develops in various places. This leads to weight gain. The water accumulation may be clearly visible on the face (facial edema), especially on the eyelids (eyelid edema) or may form on the lungs. Pulmonary edema manifests with cough, rattling breath sounds, pale to bluish skin color, palpitations, and shortness of breath. As a complication of the disease, the lack of protein can lead to blood clotting disorders. This favors the development of thrombosis and blood clots, especially in the renal veins. The severity of the symptoms of nephrotic syndrome varies from person to person. Some patients suffer from severe symptoms, while others hardly feel anything. The disease can lead to chronic kidney weakness and even kidney failure.
Diagnosis and course
Nephrotic syndrome can be primary or secondary. Secondary nephrotic syndrome always occurs in association with diseases, such as HIV or cancer. In the primary form, there is no relationship to other diseases. If the secondary form is present, the disease can usually be treated successfully with glucocorticoids. However, relapse often occurs. However, if the nephrotic syndrome is based on focal glomerulosclerosis, then treatment proves particularly difficult. This is because scar tissue is then found in the renal corpuscles, so that the renal filter can no longer perform its function adequately. This can lead to complete loss of kidney function. In addition to a conventional urine sample, 24 hours of urine must be collected. A blood test will also provide more information, as protein levels can thus be checked. However, lipid metabolism values are also of high importance. Last, a kidney biopsy will be ordered, using a needle to remove a one or two centimeter piece of kidney tissue.
Complications
In this syndrome, patients suffer from a number of different complaints and symptoms.For this reason, the further course of this disease depends very much on the severity of these symptoms. First and foremost, patients suffer from a significantly increased susceptibility to infections and a weakened immune system. Inflammations and infections occur more frequently, so that the patient’s life expectancy may also be reduced as a result. Blood clotting disorders or thrombosis may also occur due to this syndrome, further reducing the patient’s quality of life. Similarly, bloody urine and severe pain in the flanks occur. These may also work their way into the back. If there is no treatment for this syndrome, the patient may also experience complete renal failure and die from it. Treatment of this condition is usually done with the help of medications. Special complications do not usually occur. In severe cases, the affected person is thereby dependent on dialysis or on the transplantation of a kidney in order to continue to survive.
When should you go to the doctor?
Disturbances in heart rhythm, palpitations or elevated blood pressure are signs of impaired health. If the symptoms persist, a doctor should be consulted. An inner heat, slight excitability as well as a feeling of restlessness are further signs that should be clarified. In case of sweating, sleep disturbances as well as shortness of breath, the affected person needs help. If anxiety, behavioral problems or mood swings develop, consultation with a doctor is recommended. Breathing noises, changes in the appearance of the skin and swelling on the body are cause for concern. If water retention, changes in weight or disturbances of the musculoskeletal system occur, an investigation of the cause is indicated. If the joints can no longer be moved as usual or the general physical resilience decreases, a doctor should be consulted. Discoloration of the skin, internal weakness and diffuse malaise should be investigated and treated. If the affected person experiences a feeling of illness, loses zest for life, and can no longer participate in the usual social as well as societal activities, the observations should be discussed with a physician. Abnormalities in urination, pain in the kidney area and changes in body odor are alarm signals from the organism. They should be immediately assessed by a medical professional.
Treatment and therapy
Initially, nephrotic syndrome is treated with glucocorticoids. If there are frequent relapses, then no cure can be achieved with the help of this medicine, so other drugs must be used. These include mycophenolate mofetil, cyclosporine or cyclophosphamide. In some patients, a combination therapy has a particularly positive effect. The edema is controlled by a low-salt diet, expectorants and reduced drinking. In particularly stubborn cases, albumin infusions are used, as this can compensate for the loss of protein via the urine. ACE inhibitors can be taken to reduce protein excretion. These also lower blood pressure. In some patients, other antihypertensive drugs must also be used. Despite treatment, nephronic syndrome can lead to irreversible damage to the kidneys, so that a kidney transplant is the last resort. Fortunately, however, this is the case in only a minimal proportion of all sufferers.
Outlook and prognosis
The prognosis of nephrotic syndrome depends on the type of syndrome, the causative disease, and the time of diagnosis. The prognosis is particularly good when the syndrome has arisen from glomerulonephritis. Children can be treated in a targeted manner, causing the syndrome to regress in many cases. Other forms of nephrotic syndrome offer a worse prognosis. In most cases, drug treatment with immunosuppressants is necessary, which is associated with serious side effects and interactions. Nephrotic syndrome may also be an expression of severe renal disease. Diabetics and patients with antibasement membrane glomerulonephritis have a much worse prognosis, since the causative disease is already far advanced when nephrotic syndrome occurs. The prognosis is determined by the nephrologist or general practitioner in charge. For this purpose, the previous course of the disease and the stage in which the disease is located are used.Spontaneous improvement in health is possible, but short-lived. Life expectancy in the severe form is severely limited. Many patients die within a few years of diagnosis. In the milder forms, complete recovery is possible, with no late sequelae.
Prevention
Since nephrotic syndrome is often a consequence of other diseases, one should take care of oneself and one’s body by adopting a healthy lifestyle. The kidneys should always be well flushed, which is why the intake of water is particularly important. About two to three liters should be taken in per day. But also the unnecessary and excessive intake of medication should be refrained from. If there is a slight suspicion of nephrotic syndrome, the doctor should be consulted immediately, since rapid treatment often promises greater success. Furthermore, diseases that may possibly trigger nephrotic syndrome should be treated at an early stage.
Follow-up
In nephrotic syndrome, follow-up care consists of ongoing treatment of the causes. This includes controlling the kidney infection as well as optimally adjusting diabetes and discontinuing inappropriate medications. If the nephrotic syndrome is based on an autoimmune disease, cortisone is used. Symptoms associated with fluid retention in the abdomen can be relieved by eating several small meals spread throughout the day. Diuretics are used for high blood pressure and help reduce tissue swelling caused by fluid retention. These medications are prescribed by the physician at regular follow-up visits and the dose is adjusted to the patient’s individual needs. Since infections can be life-threatening, they must be treated immediately. Preventive pneumococcal vaccination is recommended for those affected. In nephrotic syndrome, the prognosis depends on the cause of the disease. To help the healing process, care should be taken to ensure adequate protein intake. If the body receives too little protein, there is a risk of increased muscle mass loss. Per kilogram of body weight, 0.8 to 1 gram of protein daily is generally recommended. Type 2 diabetics should reduce dietary salt intake and limit it to no more than six grams daily. To reduce salt consumption, the intake of processed foods can be reduced while increasing the consumption of unprocessed foods such as fruits and vegetables.
Here’s what you can do yourself
Nephrotic syndrome is associated with a variety of symptoms. Sufferers can relieve some of the symptoms themselves by adjusting their lifestyle. Exercise and avoiding stress help combat high blood pressure. Smokers should give up smoking. The diet should be changed to a Mediterranean diet, which is best composed of raw vegetables, nuts, pasta, eggs and cheese. Salt, caffeine and alcohol increase blood pressure and should be avoided. If edema develops, it must be treated according to the doctor’s instructions. Affected children and adolescents should use special skin care products to prevent further irritation of the sensitive skin. Since nephrotic syndrome also carries an increased risk of blood clots, parents should watch for unusual symptoms and call a doctor if in doubt. It is also important to wear compression stockings and take blood-thinning measures. The increased susceptibility to infection can be counteracted by washing clothing and bed linen hot several times a week and by the patient avoiding dangerous situations in everyday life. Should a bacterial infection nevertheless occur, a visit to the doctor is recommended. A change in diet and other self-help measures should first be discussed with the responsible physician in order to avoid complications.
