Nephrotic syndrome - a disease characterized by proteinuria, edema, hyperlipidemia, hypoalbuminemia, increased blood clotting, lipiduriya. As a result of various immune disorders, metabolic disorders, toxic exposure, degenerative processes in the body is changing glomerular capillary walls, causing excessive filtration of plasma proteins. Thus, acute nephritic syndrome is a consequence of pathological conditions that lead to increased permeability of the glomerular capillary wall.
The main causes of nephrotic syndrome
A huge role in the development of nephrotic syndrome immunological mechanisms play. The main reasons for the development of primary neurotic syndrome are:
- mesangial proliferative glomerulonephritis;
- membranous glomerulonephritis (idiopathic nephrotic syndrome in adults);
- membranous-proliferative glomerulonephritis;
- lipoid nephrosis (minimal change nephropathy, idiopathic nephrotic syndrome in children);
- focal segmental glomerulosclerosis.
Secondary nephrotic syndrome develops as a result of:
- infectious disease (leprosy, secondary syphilis, infectious endocarditis, hepatitis B and al.);
- and toxic effects of medicines (heavy metals, non-steroidal anti-inflammatory agents, penicillamine, antitoxins, captopril, etc.);
- systemic connective tissue diseases;
- family and hereditary diseases;
- other immune diseases;
- rheumatoid arthritis;
- sickle-cell anemia;
- systemic lupus erythematosus;
- tumors (leukemia, lymphoma, melanoma, carcinoma, lymphoma);
- Henoch's disease.
It should be noted that the nephrotic syndrome in children is about four times more often than adults.
The symptoms of nephrotic syndrome
The main clinical symptom of nephrotic syndrome are swelling. Swelling may develop gradually, but some patients they occur very quickly. At first they appear on the face, eyelids, waist and genitals, and then spread to the entire subcutaneous area, often reaching a degree of hydrops. Patients seen in serous cavities transudates: ascites, hydrothorax, hydropericardium. Type of patients becomes pale, with a puffy face and swollen eyelids. Despite strong pallor, anemia, usually non-existent or is moderate.
If a patient develops symptoms of nephrotic syndrome as kidney failure, anemia becomes severe. When ascites patients complain of indigestion. Patients with hydrothorax hydropericardium and shortness of breath. Cardio activities are the following symptoms of nephrotic syndrome: appearance of systolic murmur over the apex of the heart, muted tones, beats, change the final part of ventricular complex cardiac arrhythmia, which in the absence of other diseases of the heart can be defined as nephrotic dystrophy infarction resulting from a violation of metabolism , hypoproteinemia and electrolyte metabolism.
Acute nephritic syndrome is characterized by a sudden onset of proteinuria and hematuria. Develop symptoms of azotemia, there is a delay in the body of water and salt, hypertension.
Diagnosis of nephrotic syndrome
Laboratory data play a crucial role in the diagnosis of nephrotic syndrome. Nephrotic syndrome observed increased ESR, sometimes up to 50-60 mm for 1 hr. The glomerular filtration typically normal or slightly increased. Relative density of urine increased, and its maximum values can reach 1030-1060. The precipitate was scanty urine, with a small amount of fat and hyaline cylinders, fat cells. In some cases, there is microscopic hematuria. In acute nephrotic syndrome, have developed in patients with hemorrhagic vasculitis, amid glomerulonephritis or lupus nephropathy may experience severe hematuria.
Actually, the diagnosis of nephrotic syndrome does not pose any difficulties, but the identification of the main reasons for the doctor can give some difficulties, because it affects the choice of adequate treatment of nephrotic syndrome. In order to identify the reasons for your doctor may recommend the patient to undergo a complete clinical, instrumental and laboratory examination.
The course and prognosis of nephrotic syndrome
Many factors determine the difficulty of the course and prognosis of the disease. This age of the patients, the cause of the disease, clinical symptoms, morphological characteristics, the presence of complications and the adequacy of the treatment of nephrotic syndrome. For example, nephrotic syndrome in children (lipoid nephrosis has the most favorable prognosis as prone to remission and responds well to corticosteroids.
The prognosis for primary membranous glomerulonephritis much worse. Typically, during the first 10 years thirds adult patients develop chronic renal failure, and as a result, fatal. In the primary nephrotic syndrome resulting from kidney disease, the prognosis is even worse. For 5-10 years in patients developing severe renal failure requiring dialysis or a kidney transplant, and hypertension. Forecast secondary nephrotic syndrome defined course and nature of the underlying disease.
Treatment of nephrotic syndrome
Patients with the disease should observe moderate physical activity, as hypokinesia promotes thrombosis. Appointed salt-free diet, minimizes all the foods that contain sodium. The volume of fluid injected should not exceed the daily urine output of 20-30 ml. In normal patients total calories protein administered rate of 1 g per kilogram of body weight. Food should be rich in vitamins and potassium.
Typically, when a renal edemas are reduced, while increasing the amount of salt to a patient in order to avoid its scarcity, and allowed to take more fluid. If there azotemia, the amount of protein administered is decreased to 0, 6 g / kg body weight per day. Treatment of nephrotic syndrome albumin is only advisable in patients with severe orthostatic hypotension.
In severe edema patients prescribed diuretics. The most effective ethacrynic acid, furosemide, which may be combined with veroshpironom or triamterene.
In recent years, it became widespread in the treatment of nephrotic syndrome, the use of antiplatelet agents and heparin, which is particularly suitable for patients who are prone to hypercoagulable.