Occurs this condition usually hard. This process can be complicated by patient age, clinical symptoms, underlying medical conditions. The probability of a positive outcome is directly connected with adequately chosen and promptly begin treatment.
Nephrotic syndrome — what it is
Renal syndromes are diagnosed on the basis of information about changes in blood and urine. This type of disease is accompanied swelling, lokalizirutesa throughout the body, in addition, they are characterized by increased blood clotting. Nephrotic syndrome is a disorder of the kidneys, thereby increasing the amount of protein removed from the body through urination (this is called proteinuria). In addition, if the pathology is reduced albumin in the blood and interferes with the metabolism of fats, proteins.
Nephrotic syndrome — causes
Are still incompletely understood causes of nephrotic syndrome, but it is already known that they are divided into primary and secondary. Among the former is a hereditary glomerulonephritis, disease of the urinary tract, congenital abnormalities of the functioning and structure of the kidneys (the illness often occurs in amyloidosis, nephropathy of pregnancy, in tumors of kidney, pyelonephritis). Secondary causes of the disease are:
- viral infections, including hepatitis and AIDS;
- diabetes mellitus;
- common medications that affect the kidneys/liver;
- blood poisoning;
- allergic reactions;
- endocarditis of chronic type;
- poisoning with chemical substances;
- congenital insufficiency of the heart muscle;
- cancerous tumors in the kidneys;
- lupus, other autoimmune diseases.
Nephrotic syndrome — classification
As described above, the disease may be primary or secondary, depending on the reasons for its occurrence. The first form of pathology is divided into acquired and hereditary. If the latter view of nephropathy is clear, then the acquired is characterized by a sudden development of the disease on the background of various kidney ailments. Classification of nephrotic syndrome also includes the idiopathic form of the disease, where its causes remain unknown (to install them). Idiopathic membranous nephropathy is more frequently diagnosed in children.
There is, moreover, another classification based on reactions to the treatment of disease with hormones. So, pathology is divided into:
- endocrine (well treated by hormonal preparations);
- insensitive to hormones (in this case the treatment is done with medicines that suppress the intensity of nephrotic syndrome).
Depending on the severity of symptoms, the kidney disease can be:
- acute (the symptoms of the disease appear only once);
- chronic (symptoms occur periodically, followed by a period of remission).
Nephrotic syndrome — pathogenesis
Pathology often affects the child, not an adult, develops a syndrome, usually in under 4 years. Statistics says that more susceptible to disease boys than girls. The pathogenesis of nephrotic syndrome is that the human body is disturbed protein and lipid metabolism, resulting in the urine accumulate these two substances that seep into the skin cells. As a consequence there is a characteristic symptoms of kidney disease – puffiness. Without proper therapy, the disease leads to severe complications, and in extreme cases may be fatal.
Nephrotic syndrome in children
It is a collective term includes the whole complex of symptoms and is characterized by extensive edema of the adipose tissue, accumulation of fluid in body cavities. Congenital nephrotic syndrome in children usually develops during infancy and up to 4 years. To determine the cause of the disease in babies is often not possible or is difficult task. Doctors associated nephropathy with a child’s immature immune system of the child and its vulnerability to a number of pathologies.
Congenital disease of the Finnish type, the child may even develop in utero and up to 3 years. The syndrome got its name due to the research of the Finnish scientists. Often nephropathy in children occurs against a background of other ailments:
- in glomerulonephritis;
- systemic lupus erythematosus;
In addition to these pathological conditions, the impetus can serve as minimal change disease or focal segmental glomerulosclerosis. Diagnosis of nephrotic syndrome in children does not appear to be a complex task: even in utero, can detect abnormalities by analyzing amniotic fluid and ultrasound.
Acute nephrotic syndrome
The disease, which was diagnosed for the first time is called «acute nephritic syndrome». To previous pathology symptoms include:
- the decline in performance, weakness;
- decreased urine output;
- edematous syndrome that begins due to a delay of water and sodium in the body (localized symptom everywhere from the face to the ankles);
- increase in blood pressure (diagnosed in 70% of patients).
Causes of acute nephrotic syndrome were eliminated by antibiotic therapy. The treatment lasts approximately 10-14 days. Pathogenetic therapy involves the use of anticoagulants (based on heparin) and antiplatelet agents (chimes). In addition, a necessary component of restoring the health of the patient is a symptomatic treatment, which involves administration of drugs that have a diuretic effect (Hydrochlorothiazide, Furosemide). In complicated, long lasting disease appointed corticosteroids and pulse therapy.
Chronic nephrotic syndrome
For this form of the disease is characterized by the change of periods of exacerbation and remission. As a rule, chronic nephrotic syndrome are diagnosed in adulthood due to improper or inadequate treatment of acute nephropathy in childhood. The main clinical signs of disease depend on its shape. Common symptoms of the syndrome is:
- increase in blood pressure;
- swelling on the body, the face;
- bad kidney function.
Self-treatment is unacceptable: the primary treatment takes place in a specialized hospital. General requirements for all patients are:
- salt-free diet;
- restriction of fluid intake;
- receiving prescribed drugs;
- following the recommended treatment;
- to avoid hypothermia, mental and physical stress.
Nephrotic syndrome — symptoms
The main symptom of kidney disease is a swelling on the body. At the first stage of the pathology she are localized mainly on the face (usually on the eyelids). After edema occur in the genital area, lower back. The symptom spread to the internal organs: fluid accumulates in the peritoneum, the space between the lungs and ribs, subcutaneous tissue and pericardium. Other signs of nephrotic syndrome is:
- dry mouth, frequent thirst;
- dizziness, severe headaches;
- violation of urination (volume of urine output decreases to a liter a day);
- diarrhea/vomiting or nausea;
- soreness, heaviness in the lumbar region;
- increasing abdominal (belly begins to grow);
- the skin becomes dry, pale;
- decreased appetite;
- shortness of breath at rest;
- a bundle of nails.
Nephrotic syndrome — differential diagnosis
To determine the shape and extent of the disease is differential diagnosis of nephrotic syndrome. The main techniques are inspection, interviews with the patient, taking laboratory tests and conduct a hard examination of the patient. Differential diagnosis is carried out by a doctor-urologist, which assesses the General condition of the patient, inspection and palpation of the swelling.
The urine and blood samples are subjected to laboratory diagnosis, which is carried out biochemical and General studies. The specialists identify low or high quantity in the fluids of albumin, protein, cholesterol. With the help of diagnostic methods is determined by the filtering capability of the kidneys. Hardware diagnostics involves:
- a biopsy of the kidneys;
- Renal ultrasound (that can detect tumors in the body);
- scintigraphy with contrast;
- a chest x-ray.
Treatment of nephrotic syndrome
Treatment of the disease requires a comprehensive approach. Treatment of nephrotic syndrome must include the use of glucocorticoids (Prednison, Prednisolone, Methapred, solu-Medrol, Methylprednisolone, Metipred) that help to relieve swelling, anti-inflammatory effect. In addition, the patient with nephropathy are assigned to cytotoxic agents (Chlorambucil, Cyclophosphamide), limiting the spread of disease, and the immunosuppressants, they are also antimetabolites, for low low immunity (this is necessary for treatment of the disease).
A necessary component of drug treatment of nephrotic syndrome is administration of diuretics – diuretics type of Verospiron, which is an effective way to relieve swelling. In addition, this condition provides for the introduction of special solutions into the blood – infusion therapy. Drugs, concentration and volume of the doctor calculates individually for each patient). Such medicines include antibiotics and albumin (a plasma substitute substance).
Diet for nephrotic syndrome
Patients with nephropathy when pronounced edema and abnormal protein in the urine necessarily need to follow a diet. It is aimed at the normalization of metabolic processes and the prevention of further formation of edema. Diet for nephrotic syndrome involves the use of not more than 3000 kcal per day, with food should be ingested in small quantities. During treatment of the syndrome need to abandon spicy, fatty foods, minimize salt in the diet and reduced fluid intake to 1 liter a day.
In nephrotic syndrome, should be excluded from the menu the following products:
- bakery products;
- fried foods;
- hard cheeses;
- dairy products with high fat content;
- fatty foods;
- carbonated beverages;
- coffee, strong tea;
- seasonings, marinades, sauces;
Complications of nephrotic syndrome
Incorrect or delayed treatment nephropathy may lead to negative consequences, including the spread of infections due to a weakened immune system. This is because during the therapy suppresses the immune system drugs to increase the effects of certain medicines on diseased organs. Possible complications of nephrotic syndrome include nephrotic crisis, in which proteins in the body are reduced to a minimum, and HELL is growing.
Life-threatening complication can be a brain edema, which develops as a result of accumulation of fluid and pressure inside the skull. Sometimes nephropathy leads to pulmonary edema and infarction, which is characterized by necrosis of the heart tissue, the appearance of clots in the blood, thrombosis of veins and arteries, atherosclerosis. If the pathology revealed a pregnant woman for her fetus is in danger of preeclampsia. In extreme cases, the doctor recommends to resort to abortion.