Nephrotic Syndrome

Nephrotic syndrome is a syndrome (group of symptoms) caused by a number of disorders affecting the kidneys and lead to a strong, long-term loss of protein in the urine (especially albumin), retention of excess salt and water in the body and increased levels of fats (lipids) in the blood.

Nephrotic syndrome can occur at any age. In children, the most common between 18 months and 4 years of age and affects boys more often than girls. For older people are equally affected both sexes.

Causes

Nephrotic syndrome can cause any of the glomerulopathies and a range of diseases. Drugs that are harmful to the kidneys can also cause nephrotic syndrome, as well as intravenous heroin. The syndrome may be associated with certain hypersensitivity. Some forms of hereditary syndromes.

Nephrotic syndrome associated with HIV infection, develops mostly in blacks. The syndrome progresses to complete kidney failure within 3 to 4 months.

Symptoms

Early symptoms include loss of appetite, general body weakness, swollen eyelids, abdominal pain, loss of muscle mass, tissue swelling due to retention of excess salt and water and cloudy urine. The abdomen may be increased due to the accumulation of large amounts of fluid in it, and shortness of breath may occur due to an accumulation of fluid around the lungs (pleural effusion). Other symptoms may include swelling of the knees and, in men, the scrotum. The most common fluid that causes swelling moves through the body, causing swelling of the eyelids morning and swelling of the ankles after walking. Loss of muscle mass can be disguised islands.

In children can cause a fall in blood pressure when standing up and are generally of low blood pressure. Adults may have low, normal or high blood pressure. It can reduce the excretion of urine and may develop kidney failure due to a small volume (volume) levels and reduced blood flow to the kidney. Sometimes you suddenly develop kidney failure with poor excretion of urine. In the first medical examination level of protein in the patient's urine is usually high.

Due to the loss of nutrients in urine, such as glucose, can lead to malnutrition. The growth can be slowed down (in children, op. Trans.). From the bones can lose calcium. Hair and nails can become brittle and hair may fall out. In the nail bed, for unknown reasons, to develop horizontal white lines.

                                     What can cause nephrotic syndrome?

Disease

• Amyloidosis

• Cancer

• Diabetes (Diabetes)

• glomerulopathies

• Human immunodeficiency virus (HIV)

• Leukemia

• Lymphomas

• Monoclonal gammopathy

• Multiple myeloma

• Systemic lupus erythematosus (SLE)

Medicines

• Medications for pain (analgesics) like aspirin (aspirin)

• Gold

• Intravenous heroin

• penicillamine

Allergies

• insect bites

• Poison ivy

• Poison Oak

• Sunlight

The peritoneum can be turned on (peritonitis). There are frequent opportunistic infections-infections caused by bacteria that are normally harmless to healthy people. It is believed that a high incidence of infection of consequence of loss of the antibody (which is normally fight infection) in the urine, or that the antibody does not form in a sufficient amount. The coagulation of blood becomes abnormally resulting in increased risk of blood clots within the blood vessel (thrombosis), especially inside the main renal vein. On the other hand, the blood can be harder coagulate which leading to profuse bleeding. High blood pressure accompanied by complications affecting the heart and brain, and are most likely to occur in people with diabetes and in those with connective tissue disease.

Diagnosis

The diagnosis of nephrotic syndrome is made based on symptoms and laboratory findings. Urine laboratory tests revealed high levels of protein with clusters of cells (cylinders). The concentration of albumin in the blood is low because it is vitally important protein lost in the urine, and its formation is disrupted. The level of sodium in the urine is low, and high potassium.

Concentrations of fats (lipids) in the blood are high, sometimes up to 10 times higher than normal or even higher than that. The level of lipids in the urine is also high. It can be present, and anemia. Blood clotting factors may be elevated or reduced.

The doctor will look for possible causes of nephrotic syndrome, including medications. The analysis of blood and urine tests can detect underlying disease. If a person loses weight, or is older, take the quest for cancer. Of particular benefit kidney biopsy to determine the specific damage to the kidney tissue.

Prognosis

Prognosis varies depending on the cause of nephrotic syndrome, age and type of damage to a person who is determined by microscopic examination of tissue samples taken (biopsy). If the nephrotic syndrome consequence of a disease that can be treated, such as cancer or infection, or cause the drugs, the symptoms can disappear completely. This outcome occurs in about half the cases in children, but rarely in adults. The prognosis is generally good, if basic disease responds to corticosteroids. When the syndrome is a result of infection with HIV, inexorably progresses. Children born with the nephrotic syndrome rarely survive beyond their first birthday, although a few survived thanks to dialysis or kidney transplantation.

Nephrotic syndrome has the best prognosis when the consequences of mild forms of glomerulonephritis, minimal change disease called; in about 90% of children and adults almost as much treatment is effective. The disease rarely progress to kidney failure, although it can be repeated. However, if the disease was a quiet year, it is unlikely that he will return.

Membranous glomerulonephritis is a more serious form of glomerulonephritis that cause nephrotic syndrome. Encountered mainly in adults and is slowly progressing toward renal failure in 50% of people above 15 years of age. The remaining 50% do not have a disease or permanently secreted proteins in the urine, but with the proper functioning of the kidneys. In most children with membranous glomerulonephritis proteins from urine disappear on their own and completely within five years of diagnosis.

The two remaining forms of family nephrotic syndrome and membranoproliferative glomerulonephritis, respond poorly to treatment and the prognosis is less optimistic. In more than half of people with a family form develops kidney failure within 10 years. In 20% of the forecast is even worse; severe kidney disease develops within 2 years. The disease progresses faster in adults than in children. In half of people with type membrano develops kidney failure within 10 years; disease disappears in less than 5% of patients. In another form, such as mesangial proliferative glomerulonephritis corticosteroids practically never have any effect.

Nephrotic syndrome that occurs in conjunction with systemic lupus erythematosus (SLE), amyloidosis, or diabetes, the treatment is aimed at alleviating the symptoms rather than the curing. While newer methods of treatment of systemic lupus erythematosus alleviate symptoms and stabilized in repairing or abnormal test results, progressive (progressive) renal failure occurs in most patients. Nephrotic syndrome in diabetes usually develops in severe renal disease for 3 to 5 years.

In cases of nephrotic syndrome, which is caused by conditions such as infections, allergies or intravenous heroin, forecasts vary, depending on how early and effectively treated by primary disease.

Treatment

Treatment is focused at the basic disease. Treatment of infection that causes nephrotic syndrome may eliminate symptoms. If the result of the syndrome treatable diseases,  such as Hodgkin's disease or other types of cancer, treatment of the underlying disease can be eliminated renal symptoms. When drug addicts who take heroin and have nephrotic syndrome, cessation of drug use in the early stages of the disease leads to the disappearance of symptoms. People allergic to sunlight, ivy or similar plants and insect bites should avoid such stimuli. Injections of allergens (desensitization) could void the nephrotic syndrome associated with these stimuli. If drugs are responsible for the syndrome, drug suspension may lead to the disappearance of kidney problems.

If the cause can not be determined, the person is given corticosteroids and drugs that suppress the immune system, eg. Cyclophosphamide. Such drugs, however, can cause problems in children because it can lead to growth retardation and slow sexual development.

General treatment includes a diet with normal amounts of protein and potassium, or with a low content of fat and sodium. Too much protein in the diet raises the level of protein in the urine. Inhibitors of enzyme which convert angiotensin (ACE inhibitors), for example. Enalapril, captopril and lisinopril, generally reduce protein loss in the urine and blood lipid levels. However, these drugs may increase the concentration of potassium in the blood in people with moderate to severe impaired renal function.

If the abdominal cavity accumulates fluid, often taking smaller meals can help reduce symptoms. High blood pressure is usually treated with diuretics. Diuretics can also reduce fluid retention and tissue islands, but may increase the risk of blood clots. If this happens, help anticoagulants. Infections can be life threatening and must be treated immediately. See also Plummer Vinson syndrome.