Nephrotic syndrome is understood in medicine as a combination of several symptoms. These occur in various diseases of the kidney corpuscles.
What is Nephrotic Syndrome?
The four cardinal symptoms of nephronic syndrome are edema, proteinuria to a large extent, hyperlipoproteinemia and hypoproteinemia. Proteinuria is a protein excretion in the urine that is more than 3.5 grams per day. See phonecations for All You Need to Know About Hirsuties Papillaris Penis.
Edema causes tissue swelling as water builds up in the body. A reduced concentration of protein is understood as hypoproteinemia. Hyperlipoproteinemia describes an increase in cholesterol and lipoproteins. All of these symptoms arise because the kidneys are no longer filtering the blood properly. The kidney is made up of a million small filtering units called glomeruli, or corpuscles.
However, the filter membrane is more permeable as soon as nephrotic syndrome is present. The organism therefore tries to compensate for the lack of protein that is caused by reduced breakdown and increased production of fat.
Causes
The most common causes of nephrotic syndrome include chronic renal corpuscle disease and minimal change glomerulonephritis, a renal corpuscle disease that occurs most commonly in children.
About 15% of the nephronic syndrome is caused by a chronic disease of the kidneys. In this so-called focal segmental glomerulosclerosis, not all kidney corpuscles are damaged in comparison to the other two diseases.
Rarer causes include progressive kidney disease, kidney involvement in collagenosis and amyloidosis, renal venous congestion, kidney damage from plasmacytoma, and complications that can occur with malaria.
Symptoms, Ailments & Signs
The nephrotic syndrome is accompanied by some typical symptoms. First of all, the loss of protein is in the foreground. It’s called proteinuria. The protein is excreted in the urine; clearly recognizable by heavy foaming. A lack of protein can also be detected in the blood, which is referred to as hypoproteinemia. In addition, the blood fat levels rise. This in turn increases the risk of a heart attack and coronary artery disease.
In addition, patients often suffer from hypertension. Since the organism also loses antibodies due to the impaired kidney function, infections occur more frequently. In addition, water collects in the abdomen (ascites) and edema develops in various places. This leads to weight gain. The accumulation of fluid can be clearly seen on the face (facial oedema), especially on the eyelids (eyelid oedema) or form on the lungs.
Pulmonary edema manifests itself with coughing, rattling breath noises, pale to bluish skin color, tachycardia and shortness of breath. As a complication of the disease, the lack of protein can lead to blood clotting disorders. This promotes the formation 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 discomfort, while others hardly feel anything. The disease can lead to chronic kidney weakness and kidney failure.
Diagnosis & History
Nephrotic syndrome can be primary or secondary. The secondary nephrotic syndrome always occurs in conjunction with diseases such as HIV or cancer. The primary form is unrelated to other diseases. If the secondary form is present, the disease can usually be successfully treated with glucocorticoids.
However, relapses often occur. However, if the nephrotic syndrome is due to focal glomerulosclerosis, then treatment is particularly difficult. Then scar tissue can be found in the kidney corpuscles, so that the kidney filter can no longer perform its function adequately. This can lead to a complete loss of kidney function.
In addition to a conventional urine sample, urine must be collected for 24 hours. A blood test will also provide more information, since the protein level can be checked in this way. But lipid metabolism values are also of great importance. Finally, a kidney biopsy is done, using a needle to remove a piece of kidney tissue a centimeter or two long.
Complications
With this syndrome, patients suffer from a variety 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, the patients suffer from a significantly increased susceptibility to infections and a weakened immune system. Inflammation and infections occur more frequently, so that the life expectancy of the patient may also be reduced.
A blood clotting disorder or thrombosis can also occur due to this syndrome and further reduce the patient’s quality of life. There is also bloody urine and severe pain in the flanks. These can also work their way into the back. If this syndrome is not treated, the patient can also suffer from complete renal insufficiency and die from it.
This condition is usually treated with medication. As a rule, no particular complications arise. In severe cases, the affected person is dependent on dialysis or a kidney transplant in order to continue to survive.
When should you go to the doctor?
Cardiac rhythm disturbances, tachycardia or increased blood pressure are signs of health problems. If the symptoms persist, a doctor should be consulted. An inner heat, easy excitability and a feeling of restlessness are further signs that should be clarified. If you break out in a sweat, have trouble sleeping or have shortness of breath, you need help. If fears, behavioral problems or mood swings develop, it is advisable to consult a doctor. Breathing noises, changes in the complexion and swelling on the body are worrying. If there is water retention, changes in weight or disorders of the musculoskeletal system, it is advisable to investigate the causes.
If the joints can no longer be moved as usual or if the general physical resilience decreases, a doctor should be consulted. Skin discoloration, internal weakness, and diffuse malaise should be evaluated and treated. If the affected person experiences a feeling of illness, if he loses his zest for life and if he can no longer take part in the usual social and community activities, the observations should be discussed with a doctor. Abnormal urination, pain in the kidney area and changes in body odor are alarm signals from the organism. They must be examined immediately by a doctor.
Treatment & Therapy
Initially, the nephrotic syndrome is treated with glucocorticoids. If there are frequent recurrences, this medicine cannot cure the problem, so other medicines must be used.
These include mycophenolate mofetil, cyclosporine or cyclophosphamide. Combination therapy has a particularly positive effect on some patients. Edema can be brought under control by a low-salt diet, flushing agents and drinking less. In particularly stubborn cases, albumin infusions are used, as this can compensate for the loss of protein through the urine.
ACE inhibitors can be taken to reduce protein excretion. They also lower blood pressure. Some patients may also need other antihypertensive medications. Despite treatment, nephronic syndrome can cause irreversible damage to the kidneys, so a kidney transplant is the last resort. Fortunately, however, this is only the case for a minimal proportion of all patients.
Outlook & Forecast
The prognosis of nephrotic syndrome depends on the type of syndrome, the disease that causes it, and the time of diagnosis. The prognosis is particularly good if the syndrome arose from glomerulonephritis. Children can be treated in a targeted manner, whereby the syndrome regresses in many cases.
Other forms of nephrotic syndrome offer a poorer prognosis. Drug treatment using immunosuppressants is usually necessary, which is associated with serious side effects and interactions. The nephrotic syndrome can also be an expression of severe kidney disease. Diabetics and patients with antibasal membrane glomerulonephritis have a significantly poorer prognosis, since the causative disease is already well advanced when the nephrotic syndrome occurs.
The responsible nephrologist or general practitioner makes the prognosis. 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, a full recovery is possible without long-term effects to be expected.
Prevention
Since nephrotic syndrome is often a consequence of other diseases, you should take care of yourself and your body through a healthy lifestyle. The kidneys should always be well flushed, which is why drinking water is particularly important. About two to three liters should be consumed per day.
But the unnecessary and excessive intake of medication should also be avoided. If there is a slight suspicion of nephrotic syndrome, the doctor should be consulted immediately, as rapid treatment often promises greater success. Furthermore, diseases that can possibly trigger the nephrotic syndrome should be treated early.
Aftercare
Follow-up care for nephrotic syndrome consists of continuous treatment of the causes. This includes combating the kidney infection as well as the optimal control of the diabetes and the discontinuation of unsuitable medication. If the nephrotic syndrome is based on an autoimmune disease, cortisone is used.
Symptoms of fluid accumulation in the abdomen can be relieved by eating several small meals throughout the day. Diuretics are used for high blood pressure and help reduce tissue swelling caused by fluid retention. These drugs are prescribed by the doctor during regular follow-up examinations and the dose is adjusted to the individual needs of the patient.
Da Infektionen lebensgefährlich sein können, müssen diese sofort behandelt werden. Den Betroffenen wird eine vorbeugende Pneumokokken-Impfung empfohlen. Die Prognose hängt beim nephrotischen Syndrom von der Ursache der Erkrankung ab. Um den Heilungsvorgang zu unterstützen, sollte auf eine angemessene Eiweißzufuhr geachtet werden. Wenn der Körper zu wenig Eiweiß erhält, besteht das Risiko, dass vermehrt Muskelmasse abgebaut wird.
Pro Kilogramm Körpergewicht werden in der Regel 0,8 bis 1 Gramm Eiweiß täglich empfohlen. Typ 2-Diabetiker sollten die Kochsalzaufnahme mit der Nahrung reduzieren und auf höchstens sechs Gramm täglich beschränken. Zur Reduktion des Salzkonsums kann die Zufuhr verarbeiteter Lebensmittel reduziert werden, während gleichzeitig der Verzehr unverarbeiteter Nahrungsmittel wie Obst und Gemüse gesteigert wird.
You can do that yourself
Nephrotic syndrome is associated with various symptoms. Those affected can relieve some of the symptoms themselves by making lifestyle changes. Exercise and avoiding stress help against high blood pressure . Smokers should quit 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 care products so that the sensitive skin is not further irritated. Since there is also an increased risk of blood clots with nephrotic syndrome, parents should watch out for any unusual symptoms and, if in doubt, call a doctor. 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 several times a week in hot water and by the patient avoiding dangerous situations in everyday life.
However, should a bacterial infection occur, it is advisable to consult a doctor. A change in diet and other self-help measures should first be discussed with the responsible doctor in order to avoid complications.
