Nephrotic syndrome is a group of symptoms that appear when the glomeruli are damaged. It is a very serious condition that can lead not only to kidney failure, but also to blood clots and less serious but troublesome complications: brittleness of hair and nails, and even baldness. What are the causes and symptoms of nephrotic syndrome? What is the treatment for this kidney disease?

Nephrotic syndromeis not a disease, but a group of symptoms and laboratory abnormalities that result from glomerular dysfunction. Then it comes to proteinuria, i.e. the presence of a large amount of protein, specifically albumin, in the urine. Their amount in the urine is much greater than the amount of proteins produced by the liver, which means that their concentration in the blood is below normal. How much protein will pass through the glomeruli depends on the degree of damage - the more it is, the greater the amount of protein in the urine. It should be emphasized that proteinuria itself also contributes to damage to the renal glomeruli, and therefore leads to an even greater impairment of kidney function.

Nephrotic syndrome - causes

The cause of nephrotic syndrome are diseases in the course of which the structures of the glomeruli are damaged. In most cases, these are glomerular diseases (expertlyprimary glomerulopathies ), incl. submicroscopic glomerulonephritis, which is most common in children. In adults, 60 percent. In cases of nephrotic syndrome, primary glomerulonephritis is the cause. In other cases, systemic diseases ( secondary glomerulopathies) are responsible for renal dysfunction:

  • metabolic diseases: diabetic nephropathy (diabetic kidney disease), amyloidosis (renal amyloidosis), hypothyroidism;
  • systemic lupus erythematosus;
  • rheumatoid arthritis;
  • neoplasms (lymphomas, multiple myeloma, lung cancer, breast cancer, colorectal cancer, gastric cancer, kidney cancer);
  • infections (hepatitis C or B, HIV, malaria, syphilis);

Nephrotic syndrome can also be a reaction to drugs and nephrotoxic substances (non-steroidal anti-inflammatory drugs, gold, penicillamine, heroin), as well as the result ofpoisoning with heavy metal s alts (mercury, gold, bismuth). Allergens, venoms (bees, wasps, snakes) and even vaccines can also contribute to the appearance of the symptom complex.

Nephrotic syndrome - symptoms

  • proteinuria-the loss of protein in urine is over 3.5 g per day, and in severe cases even over a dozen grams per day (the norm is about 250 mg per day). For children, this value is converted into a kilogram of body weight and is over 50 mg / kg b.w. daily;
  • hypoalbuminemia, i.e. lowering the concentration of protein (albumin) in the blood ( <2,5 mg/dl);
  • hyperlipidemia, i.e. disorders of the body's fat metabolism - usually high blood lipids, mainly cholesterol;
  • edema - low blood protein levels and sodium retention by diseased kidneys are the reasons for the accumulation of water in the body, and thus - edema. They appear mainly around the eyes (most often in the morning) and in the ankles. The latter increase in a standing position, and the largest become in the evening. As the disease progresses, they permanently cover the shins and thighs, and then the sacrum and lower abdomen;
  • hypertension;
  • foaming of urine (the result of excess protein in the urine);
  • abdominal pain, loss of appetite, nausea, vomiting (the result of swelling of the gastrointestinal mucosa);

Nephrotic syndrome - complications

With prolonged proteinuria, malnutrition and thromboembolic complications (as a result of impaired blood outflow) may occur. A less serious but troublesome complication is alopecia, mainly caused by the loss of protein from the body.

Nephrotic syndrome - diagnosis

The tests on the basis of which the diagnosis is made are blood tests (ESR, complete blood count, blood chemistry tests - electrolytes, kidney function, liver enzymes, lipid metabolism, glucose, total protein and albumin) and urine (protein and creatinine).

Nephrotic syndrome - treatment

The first thing to do is to find out what is causing the nephrotic syndrome and treat the underlying disease. When the cause lies in the kidneys themselves, treatment consists in administering appropriate doses of steroids or immunosuppressive drugs (cyclosporin A). Subsequently, symptomatic treatment can be applied to reduce proteinuria and edema. Then, diuretics and angiotensin converting enzyme inhibitors are used, the use of which reduces proteinuria. In patients at high risk of embolism, thromboprophylaxis is required.

Less steroids to treat kidney

Proteinuriait occurs most often in children who need to be systematically monitored for the presence of protein in their urine. Although there are different methods of measurement, they all inform the patient too late, in a phase where relapse is already underway. Prof. Maciej Mazur discovered an effective and simple method of early warning against disease recurrence. The invention is currently undergoing a patent procedure conducted by the University Center for Technology Transfer of the University of Warsaw.

- I have come across nephrotic syndrome personally, so I devoted myself to this topic. The protein level during the relapse usually increases by an avalanche and in order to lower it, the child must take large amounts of steroids. Even if urine protein levels can be brought down quickly to zero, a further reduction in steroid doses must be done gradually. As a result, sick children who struggle with relapses over the years take huge amounts of drugs that cause very serious side effects - explains Prof. Maciej Mazur.

Children with proteinuria increase the risk of osteoporosis, high blood pressure, digestive and circulatory system diseases, as well as eye diseases (glaucoma and cataracts), often there is a slowdown or stunted growth and being overweight.

- I wanted to find a way to predict a relapse before the increased excretion of protein into the urine occurs, so that the child could be given a much lower dose of the steroid and maintain remission - says Prof. Masuria.

- I noticed that the surface tension of the urine of a sick child decreases a few days before the relapse. Changes in physical properties are so large that they can be detected at home without the need to use advanced and expensive methods, devices or reagents - explains the scientist. All you need is a standardized small measuring container. With it, you can measure the surface tension of urine. For now, the professor has made several prototypes of the container.

About the authorMonika Majewska A journalist specializing in he alth issues, especially in the areas of medicine, he alth protection and he althy eating. Author of news, guides, interviews with experts and reports. Participant of the largest Polish National Medical Conference "Polish woman in Europe", organized by the "Journalists for He alth" Association, as well as specialist workshops and seminars for journalists organized by the Association.

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Category:

Urology and Nephrology