Evaluation of nephrotic syndromeNephrotic syndrome is a collection of symptoms diatnosis to kidney damage. Causes include a number of kidney diseases such as focal segmental glomerulosclerosismembranous nephropathyand minimal change disease. Treatment is directed at the underlying cause. Lipiduria lipids in urine can also occur, but steroid dependent nephrotic syndrome differential diagnosis not essential for the diagnosis of nephrotic syndrome. Hyponatremia also occurs with a low fractional sodium excretion.
Nephrotic syndrome - Wikipedia
Nephrotic syndrome is a collection of symptoms due to kidney damage. Causes include a number of kidney diseases such as focal segmental glomerulosclerosis , membranous nephropathy , and minimal change disease. Treatment is directed at the underlying cause. Lipiduria lipids in urine can also occur, but is not essential for the diagnosis of nephrotic syndrome. Hyponatremia also occurs with a low fractional sodium excretion.
The main signs of nephrotic syndrome are: The renal glomerulus filters the blood that arrives at the kidney. It is formed of capillaries with small pores that allow small molecules to pass through that have a molecular weight of less than 40, Daltons ,  but not larger macromolecules such as proteins.
In nephrotic syndrome, the glomeruli are affected by an inflammation or a hyalinization the formation of a homogenous crystalline material within cells that allows proteins such as albumin , antithrombin or the immunoglobulins to pass through the cell membrane and appear in urine. Albumin is the main protein in the blood that is able to maintain an oncotic pressure , which prevents the leakage of fluid into the extracellular medium and the subsequent formation of edemas.
As a response to hypoproteinemia the liver commences a compensatory mechanism involving the synthesis of proteins, such as alpha-2 macroglobulin and lipoproteins. Nephrotic syndrome has many causes and may either be the result of a glomerular disease that can be either limited to the kidney, called primary nephrotic syndrome primary glomerulonephrosis , or a condition that affects the kidney and other parts of the body, called secondary nephrotic syndrome.
Primary causes of nephrotic syndrome are usually described by their histology: They are considered to be " diagnoses of exclusion ", i. Secondary causes of nephrotic syndrome have the same histologic patterns as the primary causes, though they may exhibit some difference suggesting a secondary cause, such as inclusion bodies. Focal segmental glomerulosclerosis FSGS . Minimal change disease MCD . Along with obtaining a complete medical history , a series of biochemical tests are required in order to arrive at an accurate diagnosis that verifies the presence of the illness.
The first test will be a urinalysis to test for high levels of proteins,  as a healthy subject excretes an insignificant amount of protein in their urine. The test will involve a hour bedside urinary total protein estimation. It is also examined for urinary casts , which are more a feature of active nephritis.
Next a blood screen, comprehensive metabolic panel CMP will look for hypoalbuminemia: Then a Creatinine Clearance C Cr test will evaluate renal function particularly the glomerular filtration capacity. Measuring the concentration of organic compounds in both liquids evaluates the capacity of the glomeruli to filter blood. Electrolytes and urea levels may also be analysed at the same time as creatinine EUC test in order to evaluate renal function.
A lipid profile will also be carried out as high levels of cholesterol hypercholesterolemia , specifically elevated LDL , usually with concomitantly elevated VLDL , is indicative of nephrotic syndrome. A kidney biopsy may also be used as a more specific and invasive test method. A study of a sample's anatomical pathology may then allow the identification of the type of glomerulonephritis involved.
Further investigations are indicated if the cause is not clear including analysis of auto-immune markers ANA , ASOT , C3 , cryoglobulins , serum electrophoresis , or ultrasound of the whole abdomen. Some symptoms that are present in nephrotic syndrome, such as edema and proteinuria, also appear in other illnesses.
Therefore, other pathologies need to be excluded in order to arrive at a definitive diagnosis. Acute fluid overload can cause edema in someone with kidney failure. These people are known to have kidney failure, and have either drunk too much or missed their dialysis. In addition, when Metastatic cancer spreads to the lungs or abdomen it causes effusions and fluid accumulation due to obstruction of lymphatic vessels and veins, as well as serous exudation. Nephrotic syndrome can be associated with a series of complications that can affect an individual's health and quality of life: The treatment of nephrotic syndrome can be symptomatic or can directly address the injuries caused to the kidney.
The objective of this treatment is to treat the imbalances brought about by the illness: In addition to these key imbalances, vitamin D and calcium are also taken orally in case the alteration of vitamin D causes a severe hypocalcaemia, this treatment has the goal of restoring physiological levels of calcium in the patient.
The treatment of kidney damage may reverse or delay the progression of the disease. The susceptibility testing in vitro to glucocorticoids on patient's peripheral blood mononuclear cells is associated with the incidence of not optimal clinical responses: Nephrotic syndrome can affect any age, although it is mainly found in adults with a ratio of adults to children of 26 to 1.
The syndrome presents in different ways in the two groups: The latter usually presents as secondary and not primary as occurs in children.
Its main cause is diabetic nephropathy. There are also differences in epidemiology between the sexes, the disease is more common in men than in women by a ratio of 2 to 1. The epidemiological data also reveals information regarding the most common way that symptoms develop in patients with nephrotic syndrome: The main causes of death are cardiovascular, as a result of the chronicity of the syndrome, and thromboembolic accidents. The prognosis for nephrotic syndrome under treatment is generally good although this depends on the underlying cause, the age of the patient and their response to treatment.
It is usually good in children, because minimal change disease responds very well to steroids and does not cause chronic renal failure. Any relapses that occur become less frequent over time;  the opposite occurs with mesangiocapillary glomerulonephritis , in which the kidney fails within three years of the disease developing, making dialysis necessary and subsequent kidney transplant.
Other causes such as focal segmental glomerulosclerosis frequently lead to end stage renal disease. Factors associated with a poorer prognosis in these cases include level of proteinuria , blood pressure control and kidney function GFR. Without treatment nephrotic syndrome has a very bad prognosis especially rapidly progressing glomerulonephritis , which leads to acute kidney failure after a few months.
Jonah Lomu was diagnosed with nephrotic syndrome in The legendary All Blacks rugby union player managed to continue to play throughout his illness, though he occasionally took time off for treatment. He was on the waiting list for a second kidney when he died suddenly of heart attack, aged 40, on 18 November From Wikipedia, the free encyclopedia.
Not to be confused with Nephritic syndrome. Retrieved 9 November Ferri's Clinical Advisor E-Book: William; Greenbaum, Larry A. Clinical Pediatric Nephrology, Third Edition. Nelson Tratado de Pediatria in Spanish.
Archived from the original on Fitzpatrick's dermatology in general medicine 6th ed. New York, NY [u. Archived from the original PDF on 24 September Retrieved 12 Sep McGraw - Hill Interamericana. Retrieved 24 August Lopez-Novoa; Manuel Pestana Retrieved 8 Sep Retrieved 11 Sep The nephrotic syndrome Beyond the Basics ". Fundamentals of Renal Pathology. Problem-oriented Medical Diagnosis Seventh ed.
It occurs during renal pathologies, during fasting, in eating disorders or during heavy physical exercise. A; Hoffman, Brian B. Archived from the original PDF on Plasma expanders are natural or synthetic substances dextran, albumin Expressed as grams per g of food.
Archived from the original on February 12, Cochrane Database of Systematic Reviews: Fundamentos de medicina Cuarta ed. Diseases of the urinary system N00—N39 , — Minimal change Focal segmental Membranous. Granulomatosis with polyangiitis Microscopic polyangiitis Eosinophilic granulomatosis with polyangiitis.
Renal tubular acidosis proximal distal Acute tubular necrosis Genetic Fanconi syndrome Bartter syndrome Gitelman syndrome Liddle's syndrome. Interstitial nephritis Pyelonephritis Balkan endemic nephropathy. Renal artery stenosis Renal ischemia Hypertensive nephropathy Renovascular hypertension Renal cortical necrosis. Cystitis Interstitial cystitis Hunner's ulcer Trigonitis Hemorrhagic cystitis Neurogenic bladder dysfunction Bladder sphincter dyssynergia Vesicointestinal fistula Vesicoureteral reflux.
Retrieved from " https: Kidney diseases Pediatrics Syndromes affecting the kidneys. CS1 Spanish-language sources es CS1 maint: Views Read Edit View history.
Swelling , weight gain, feeling tired, foamy urine .