Nephrotic syndrome

Nephrotic syndrome (synonym argued) - a set of symptoms observed in many diseases of the kidneys. Nephrotic syndrome is characterized by proteinuria (see), low content of protein in the serum, the increase in the concentration of lipids in the blood, swelling. In the basis of pathological process with nephrotic syndrome are degenerative dystrophic changes in the kidneys. Infections can occur in both acute and chronic form.
Nephrotic syndrome as a primary disease (lipoid nephrosis) is very rare and exceptionally in children; usually nephrotic syndrome develops secondarily, as an integral part of many diseases of the kidneys, flowing with damage to the glomeruli. These include chronic poststreptococcal glomerulonephritis, glomerulonephritis with systemic diseases of connective tissue (see Collagen diseases), amyloidosis, diabetes, kidney damage due to sensitization allergens (transfusion incompatible blood groups, vaccination, drug intoxication, and others).
In General amyloidosis dystrophic lesions of the kidneys (amyloid nephrosis or renal amyloidosis) is early, the private manifestation of the General human protein metabolism, characteristic of amyloid diseases.
Morphological changes with nephrotic syndrome associated with damage to the glomeruli - a violation of the structure of the main membrane glomerular capillaries, as well as protein and protein-lipid dystrophy kidneys. Change the glomeruli of the kidney exits the blood of significant quantities of protein and enter it into the urine. This raises hypoproteinemia and edemas.
Excretory kidney function with nephrotic syndrome for a long time remains intact, however, the process ends secondary puckering of the kidneys and development izotermicheskoi uremia (see).
The clinical picture of nephrotic syndrome is varied and depends on the primary illness.
Patients with nephrotic syndrome go to the doctor due to the emergence of edema. In the absence of edema nephrotic syndrome is found in significant proteinuria.
In severe clinical there are swelling, which increased gradually grasp the subcutaneous tissue of the whole body (anasarca).
Fluid may build up in the cavities of the pleura, pericardium, abdominal cavity. Hypertension and related cardiovascular disorders are missing. Urine is excreted little (sometimes up to 300 ml per day), it brown, cloudy, with a high beats. weight (1030 - 1040), contains a large number of protein - more than 3-5 grams per day. In the Deposit urine - cell renal epithelium, dvoyakovpuklae education, a significant number of hyaline, granular and waxy cylinders, leukocytes. In the blood protein is reduced (up to 5 to 4 grams per cent), cholesterol is elevated (500-1000 mg%); sharply accelerated ROHE.
Diagnosis nephrotic syndrome is based on a large proteinuria, gipoproteinemii, hypercholesterolemia and swelling. In the absence of hypertension and hematuria. In the treatment of edema may disappear for a long time, but the protein in the urine, hypoproteinemia, and cholesterolemia remain. Despite the disappearance of oedema and normalization of blood and urine, usually occurs only remission of different duration (from 5 to 20 years).
The forecast. In bezotvetnoi stage patients feel satisfactory and can be employable. Possible long-term improvement, and in rare cases recovery. Violation of metabolism in the body depletes the sick, and they often die from accidental infection (pneumococcal peritonitis, pneumonia, erysipelas and others).
Treatment of nephrotic syndrome is the impact on the causal factors causing this condition. The most important pathogenetic therapy with corticosteroids, which leads to long-term improvement of the patients. Doctor prescribes corticosteroids and monitors the treatment. Reduces swelling shows the use narcotic diuretics (eg, gipotiazida 50 to 100 mg per day for 2-3 days a week with simultaneous dacha 2-3 g of potassium chloride per day). If there foci of infection shows the use of antibiotic - penicillin 200 000 IU 4 times a day. Patients contraindicated immunization (tetanus toxoid). In the period of remission is beneficial climatic treatment in dry and warm areas (Bairam-Ali, Kyrgyzstan, South coast of Crimea).
Prevention is different depending on diseases that caused nephrotic syndrome. The diet of patients with nephrotic syndrome (without renal failure) should be high in calories, rich in complete protein (2 g per 1 kg of body weight without edema) and vitamins, poor table salt (2-3 g).

  • Nephrotic syndrome in children