Nephrotic syndrome is a pathological condition of the body, associated with kidney damage and characterized by certain clinical and laboratory signs. Often this complex of disorders is diagnosed in adults who have not reached the age of 35 years.
Causes of nephrotic syndrome
For the nephrotic syndrome is characterized by the defeat of the glomerular apparatus of the kidneys, which are joined into groups of nephrons (structural units of the kidneys) through which blood filtration is carried out with further formation of urine. There is a change in the walls of the glomerular capillaries with an increase in their permeability, leading to disruptions in the protein and fat metabolism, which are accompanied by:
- violation of protein absorption and its entry into the urine (proteinuria);
- a significant decrease in protein concentration in the blood plasma (hypoproteinemia);
- a decrease in the albumin fraction of the plasma protein (hypoalbuminemia);
- increase in the blood cholesterol, triglycerides and phospholipids (hyperlipidemia), etc.
If abnormalities occur suddenly and are recorded for the first time, an acute nephrotic syndrome occurs, and with successive changes in exacerbations and remissions, the process is considered chronic. The exact causes of the syndrome have not yet been established, but the most common and reasonable concept of its pathogenesis is the immunological one. This theory explains the development of pathological changes due to the immune response to the action of various circulating antigens in the blood.
By origin, the nephrotic syndrome is divided into primary (as a manifestation of an independent kidney disease) and secondary (a consequence of systemic diseases with secondary involvement of the kidneys). As primary, it can be present in pathologies such as:
- Lipoid nephrosis;
- nephropathy of pregnant women;
- amyloidosis of the kidneys;
- membranous nephropathy;
- pyelonephritis;
- glomerulonephritis;
- kidney tumors.
Secondary syndrome can develop against the background of the following lesions:
- systemic lupus erythematosus;
- pre-eclampsia;
- hemorrhagic vasculitis;
- diabetes;
- amyloidosis;
- scleroderma;
- abscess of the lungs;
- hepatitis B;
- hepatitis C;
- myeloma;
- tuberculosis;
- syphilis;
- malaria;
- poisoning with heavy metals;
- snake bites, etc.
Nephrotic syndrome with glomerulonephritis
Often there is acute glomerulonephritis with nephrotic syndrome, in which renal glomeruli are exposed to infectious inflammation, often caused by streptococci or other pathogens. As a result, the immune system produces antibodies that, when bound to antigens, settle on the glomerular membrane and affect it.
Nephrotic syndrome with amyloidosis
Primary (idiopathic) nephrotic syndrome associated with amyloidosis is due to the fact that in the kidney tissues there is a deposition of protein-polysaccharide compounds causing a malfunction of the organ. There is a gradual withering away of deeply localized nephrons, degeneration of the epithelium of the tubules, and the kidneys increase in size.
Nephrotic syndrome with pyelonephritis
Infectious and inflammatory lesions of renal pelvis, calyx and renal parenchyma, provoked in most cases by E. coli, in the absence of adequate treatment can quickly lead to a violation of the excretory and filtering function of the organ. In this case, often develops a chronic nephrotic syndrome with periodic exacerbations.
Nephrotic syndrome - symptoms
Edema in nephrotic syndrome is the main clinical manifestation. First, puffiness is observed in the face area (often under the eyes), on the hands and feet, in the lumbar region. Subsequently, the liquid accumulates in the subcutaneous tissue of the whole body. Other symptoms may include:
- pallor and dryness of the skin;
- thirst;
- headache;
- poor appetite;
- bloating;
- stool disorders;
- pulling discomfort in the lumbar region;
- muscle pain;
- decreased urine output;
- convulsions;
- brittle hair and nails;
- shortness of breath, etc.
The main laboratory signs of nephrotic syndrome are manifested in the analysis of urine and blood following indicators:
- the amount of protein in the urine - more than 3 g / day;
- the amount of serum albumin is less than 27 g / l;
- the level of protein in the liquid part of the blood - below 60-50 g / l;
- the cholesterol content in the blood is more than 6.5 mmol / l.
Nephrotic syndrome - differential diagnosis
To determine the severity of organ damage, to identify provoking causes, in addition to a general examination of the nephrologist and anamnesis, the diagnosis of the nephrotic syndrome includes a number of instrumental and laboratory studies:
- general analysis of blood and urine;
- urine analysis in Zimnitskiy;
- bacteriological analysis of urine;
- biochemical analysis of blood and urine;
- blood test for clotting;
- electrocardiography;
- Ultrasonography of kidneys with dopplerography;
- nephroscintigraphy;
- kidney biopsy with microscopic examination.
Nephrotic syndrome - urinalysis
When there is a suspicion of nephrotic syndrome, the tests provide an opportunity not only to confirm the diagnosis, but also to determine the tactics of treatment. One of the most revealing is urinalysis, in which, in addition to having an elevated protein level, the following parameters are revealed in this pathology:
- blurred urine;
- increased density;
- alkaline reaction;
- the presence of leukocytes and erythrocytes;
- presence of stove and wax cylinders;
- presence of cholesterol crystals;
- a large number of microbial bodies.
Treatment of nephrotic syndrome
If a nephrotic syndrome is diagnosed, treatment should be performed in a hospital setting so that the doctor can monitor the patient's condition and the therapeutic regimen, if necessary adjust it. Primary importance is the treatment of primary pathology and other background diseases, which can complicate the nephrotic syndrome. Patients are recommended dosed physical exercise in order to avoid the development of thrombosis.
In the framework of drug therapy, intravenous injection of protein solutions is possible, as well as the following groups of drugs:
- glucocorticoids (Prednisone, Dexazon, Urbazon) - with atopic, lupus, membranous and some other types of nephropathy;
- cytostatics (Azathioprine, Cyclophosphamide, Leukeran) - with lymphogranulomatosis , sarcoidosis, Wegener's syndrome, etc .;
- anticoagulants (Heparin) - with glomerulonephritis hypertensive, malignant, acute, with shock kidney, pre-eclampsia, etc .;
- diuretics (Furosemide, Etakrinaic acid, Veroshpiron) - with pronounced swelling;
- immunosuppressants (Azathioprine, Cyclosporine) - in the detection of autoimmune diseases;
- antibiotics (Ampicillin, Doxycycline, Cefazolin) - when infectious processes are detected.
Cytostatics in nephrotic syndrome
Therapy of nephrotic syndrome with cytostatic drugs is often required in cases of the inapplicability of glucocorticosteroid therapy or the absence of its effect. Sometimes they are used in parallel with hormonal medications, which allows you to reduce dosage and severity of side effects. These drugs act on the dividing cells, preventing them from dividing. You can not take cytostatics in pregnancy, cytopenia, nephropathy without signs of activity, the presence of focal infection.
Diet with nephrotic syndrome
The diagnosis of "nephrotic syndrome" - an indication for the appointment of a diet number seven, aimed at normalizing metabolic processes and urine output, reducing edema. The main recommendations for meals are as follows:
- 5-6 meals a day;
- Exclusion of salt intake or restriction to 2-4 g per day;
- the use of dishes cooked on steamed, boiled, stewed;
- protein food is used in the amount of 1-2 g per kilogram of weight;
- increased intake of food rich in potassium (almonds, dried apricots, soya);
- reduction in the use of products that include simple carbohydrates (white bread, potatoes, white rice);
- reduction in the intake of animal fats (meat, fatty fish, eggs);
- restriction of the use of fluid (taking into account daily excretion of urine).
Complications of nephrotic syndrome
Complications of nephrotic syndrome can not only be due to the neglect of the pathological process, inadequate treatment, but also because of the use of certain medicines. The most common complications of nephrotic syndrome are:
- phlebothrombosis;
- pneumococcal peritonitis;
- pneumonia;
- pleurisy ;
- pulmonary embolism;
- infarct of the kidney;
- stroke of the brain;
- nephrotic crisis;
- peptic ulcer;
- allergic manifestations;
- diabetes mellitus and others.