Nephrotic Syndrome

General Illness Information

Common Name:  Nephrotic Syndrome.

Medical Term: None Specified

Description: Nephrotic syndrome is a syndrome ( a collection of symptoms) caused by many diseases that affect the kidneys . This results in severe protein loss in the urine, decreased blood levels of protein ( especially albumin), retention of excess salt and water in the body, causing swelling of extremities, face and abdomen.

It can occur at any age, but in children, it usually occurs between the ages of 1.5 to 4 years.

Causes:

Nephrotic syndrome may be caused by primary kidney glomerular disease, or secondary to other illnesses which cause damage to the kidney filtering mechanism.

In the primary form, immune disorders, and inflammations are the main causes. In the secondary form, many illnesses such as diabetes, cancers, collagen disorders and infections (such as HIV), as well as certain drugs may cause Nephrotic Syndrome.

Prevention: Obtain prompt treatment for throat and kidney infections. Treat underlying disorders such as diabetes mellitus and their complications.

Signs & Symptoms

  • Frothy urine, is usually the first sign.
  • Appetite loss; weakness; general malaise.
  • Fluid retention (edema) that appears first at puffy eyes and ankles, then as general puffiness of the skin, and eventually as a swollen abdomen.
  • Reduced urine production, sometimes to 20% of normal.
  • Muscle wasting.
  • Collection of fluid around the heart may cause shortness of breath and chest pain.

Risk Factors

  • Family history of nephrotic syndrome.
  • Exposure to chemical toxins.
  • Diabetes.
  • Myeloma, lymphoma
  • HIV
  • Immunosuppresion
  • Exposure to toxic substances, chemical toxins
  • Drug addiction
  • Pregnancy
  • Kidney infections.

Diagnosis & Treatment

Diagnostic tests may include laboratory studies, such as urinalysis and blood studies of protein and cholesterol, renal scans and kidney biopsy .
Severe loss of protein (over 2gm per day per sq. meter surface area is the cardinal finding and essential to the diagnosis)

General Measures:

  • Regular follow up by your doctor is essential.
  • The mild form of the illness can usually be controlled by diet and medications.
  • Parents may need counseling and help in learning to manage a child with nephrotic syndrome.
  • The treatment of nephrotic syndrome is dependent on the renal pathology obtained by the renal biopsy.

Medications:

  • The therapy of nephrotic syndrome is determined by renal pathology, and the pathologic diagnosis.
  • Based on the pathology, a variety of medications are used to treat the disorder.
  • Medications used include: prednisone, cyclophosphamide, chlorambucil and cyclosporine.
  • In secondary nephrotic syndrome, treatment of the underlying condition is very important.
  • Diuretics may be prescribed to control edema.

Activity:

Rest and graded activity in the acute phase.

Diet:

Usually a diet with normal (not excessive) protein, potassium, and low sodium and low fats is prescribed.

Possible Complications :

  • Hyponatremia (low sodium levels in the blood).
  • Low serum volume.
  • Hypertension.
  • Infections, especially kidney or peritoneal or endocardial.
  • Thrombosis or clotting disorders.
  • Kidney failure.

Prognosis

Prognosis varies with the specific causes. Prognosis is very good in secondary nephrotic syndrome, and primary illness which responds well to steroids. It is worse in membrano-proliferative glomerulonephritis, end-stage diabetic nephropathy, and focal glomerulosclerosis.

Other

Though many forms of this disease respond to treatment, relapses are common. If renal failure develops, dialysis or renal transplant can be lifesaving.

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