Nephrotic syndrome is a disorder in kidneys which causes loss of protein via urine, due to damage that occurs to clusters of blood vessels which filter water and toxic waste from body. The condition causes swelling, particularly in your feet and ankles, and increases the risk of other health problems.
Nephrotic syndrome is identified by main four features that occur in the condition. They are,
- Hypoalbuminemia which can be described as having low albumin in blood
- Proteinuria which is having protein in urine for more than 3.5g per day
- Dyslipidemia
- Edema due to salt, water retention
Causes
Many causes are identified to be associated with nephrotic syndrome. They are mainly,
Primary glomerular diseases as minimal change nephropathy,
- Congenital nephrotic syndrome
- Focal segmental glomerular sclerosis
- Membranous nephropathy
Secondary glomerular diseases as amyloidosis,
- Diabetic nephropathy
- Systemic lupus erythematosus can also cause nephrotic syndrome
Clinical Features
- Severe swelling specifically around eyes, ankles and feet,
- Frothy urine due to presence of protein
- Excess weight gains due to retention of fluid
- Loss of appetite
- Increased fatigue
Risk Factors
Many factors are identified to increase risk of causing nephrotic syndrome and they are
- Certain medications as non-steroid anti-inflammatory drugs
- Some antibiotics
- Certain infections as HIV, malaria and hepatitis
- Medical conditions as diabetes
- Systemic lupus erythematosus
- Other conditions in kidney
Complications
There are many complications associated with nephrotic syndrome which can affect the quality of lifestyle of the patients. Few of them are,
- Increased tendency to develop blood clots due to loss of anticoagulant proteins via urine
- Increased production of cholesterol and triglycerides in liver due to compensatory mechanisms
- Increased blood pressure due to fluid retention
- Acute kidney injury due to accumulation of toxic waste products in kidneys due to reduced filtration
- Increased susceptibility to get infections due to loss of proteins which are responsible to produce immunity
Nephrotic Syndrome Management
Initial Management and Dietary Control
- Treatment for nephrotic syndrome includes treating the condition that is causing it.
- Initially it is important to recommend restriction of dietary sodium intake and drugs as diuretics which increase urine output can be given.
- Sometimes diuretics have to be given via intravenous route as these patients can have malabsorption of drugs which can result in edema of gut mucosa.
- Protein intake in diet is advised to be maintained in a normal level as high protein can increase proteinuria which can result in long-term complications in kidneys.
- Some patients can be treated with albumin infusions, especially when they have absence of severe glomerular damage
Long-term Management
- Long-term use of drugs that reduce coagulation can be given to avoid complications of thrombosis due to lack of anticoagulant proteins.
- Increased cholesterol levels can result in cardiovascular complications which must be managed with drugs that reduce cholesterol as HMGCoA reductase and statins.
- Also, sepsis can occur due to reduced immunity which is the commonest reason for death among nephrotic syndrome patients.
- Hence, they need to be given pneumococcal vaccination and aggressively treated whenever they get infections.
References
- Kumar and Clerk’s Clinical Medicine -8th Edition- Parveen Kumar, Michael Clark
- Oxford Handbook of Clinical Medicine – 10th Edition
