Nephrotic syndrome

What is nephrotic syndrome?

Nephrotic syndrome is a set of symptoms in which protein appears in the urine, while protein levels in the blood are low, high levels of cholesterol and triglycerides are also present, and a high degree of risk of developing blood clots and swelling. A human person needs protein to live, there are different types of protein and every body uses protein in different ways, in building bones, muscles, other tissues and even in fighting infections. The moment the kidneys are not working properly, they allow albumin, a type of protein, to leak into the patient’s urine. By the time the person does not have enough albumin in the blood, the fluid builds up in the body and causes swelling in the legs, feet and ankles.

Prognosis of the disease?

The end of the syndrome may vary from patient to patient. Some people manage to recover from the condition but others, however, suffer from kidney disease for a prolonged period of time, and after a few months will need dialysis or a kidney transplant.

Symptoms may vary depending on the patient and the causes of nephrotic syndrome.

Symptoms of nephrotic syndrome

Edema is the most common presenting symptom and can originate in the following areas:

  • In the face and eye area.
  • In the arms and legs, specifically in the feet and ankles.
  • Abdominal area.

Other symptoms may be:

  • Skin rash or sores.
  • Foam in the urine.
  • Not being hungry.
  • Weight gain due to fluid retention.
  • spasms

Medical tests for nephrotic syndrome

The specialist will perform an initial physical examination and laboratory tests to check that the kidneys are functioning properly including:

  • Blood albumin test
  • Blood chemistry tests such as basic metabolic tests and the full set of metabolic tests.
  • Blood urea nitrogen
  • Blood creatinine test
  • Urine test

Occasionally fats may appear in the urine and cholesterol and triglyceride levels may increase. A kidney biopsy may be necessary to find the cause of the syndrome. The following tests may be done to rule out other causes:

  • Antinuclear antibody
  • Cryoglobulins
  • Complement levels
  • Glucose tolerance test
  • Hepatitis B and C antibodies
  • HIV test
  • Rheumatoid factor
  • Serum protein electropheresis
  • Serology for syphilis
  • Urinary protein electropheresis
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On the other hand, having the disease may alter the results of these medical tests:

  • Vitamin D level
  • Serum iron
  • Urinary cylinders

What are the causes of nephrotic syndrome?

It should be remembered that nephrotic syndrome is caused by different disorders that can damage the kidneys. The damage of this disease causes the expulsion of excess protein through the urine. In children the most common cause is minimal change disease. In adults the main cause is membranous glomerulonephritis. In both diseases the glomeruli of the kidneys are damaged. Glomeruli consist of structures that filter wastes and fluids.

There are other causes such as:

  • Cancer
  • Diseases such as: diabetes, lupus, myeloma and amyloidosis.
  • Genetic disorders
  • Immune disorders
  • Infections (tonsillitis, hepatitis or mononucleosis)
  • Use of certain drugs

Other renal disorders may manifest such as:

  • Segmental and focal glomerulosclerosis.
  • Glomerulonephritis
  • Mesangiocapillary glomerulonephritis

This disease can affect patients of any age. In children it usually appears between 2 and 6 years of age. On the other hand, women are more prone to suffer from this disorder than men.

Can it be prevented?

Prevention consists of adequately treating each of the conditions that can lead to nephrotic syndrome.

Treatments for nephrotic syndrome

The ultimate goal of treatment is to soften symptoms, avoid complications and slow kidney damage. On the other hand, to completely control nephrotic syndrome, treatment for the cause of the nephrotic syndrome must be achieved. Sometimes treatment may be necessary forever.

Treatments may include the following:

  • Maintain blood pressure at 130/80 mm or below to slow kidney damage.
  • Corticosteroids combined with other drugs that can suppress or calm the immune system.
  • Treat high cholesterol levels to reduce the risk of vascular and cardiac problems.
  • Follow a low sodium diet that reduces swelling of hands and legs.
  • Combine with a low protein diet.
  • Use vitamin D supplements if the syndrome becomes chronic and there is no response to therapy.
  • Use anticoagulants to prevent blood clots.

Which specialist treats it?

The nephrologist is the specialist in charge of treating this disease. Let us remember that Nephrology is the specialty within medicine that studies the anatomy of the kidneys and how they function. The objective of this specialty is to prevent, diagnose and treat kidney diseases and their final results. This is why the nephrologist is the most appropriate specialist to treat nephrotic syndrome.