Small vessels in the kidneys filter the blood and ensure that waste materials and excess water are excreted through the urinary tract and bladder. These small vessels are part of structures called glomeruli that are responsible for filtering blood. If glomerular damage occurs due to various reasons, protein substances are not filtered and may pass into the urine. This condition is called nephrotic syndrome.
What is Nephrotic Syndrome?
Nephrotic syndrome is a health problem that can affect both adults and young children and is treatable.
Nephrotic syndrome is a stand-alone disease. It's not a disease. It can be expressed as a group of symptoms caused by the kidneys not functioning fully. In this clinical syndrome, excessive leakage of protein into the urine occurs. Since the protein called albumin, which is responsible for the transport of various substances in the body, will also pass into the urine, the blood level of this substance falls below normal. Apart from these findings, other symptoms such as hyperlipidemia and edema may also occur. The occurrence of these conditions is due to the increased permeability of the glomeruli damaged due to embolism or infectious disease.
Nephrotic syndrome can affect individuals of all ages. When a picture of nephrotic syndrome develops in children, facial edema is usually the first symptom.
What are the Symptoms of Nephrotic Syndrome?
After the development of nephrotic syndrome, many signs and symptoms may occur in people:
- High amount of protein leakage into the urine, which is expressed as proteinuria
- Increase of fatty substances such as cholesterol and triglycerides in the bloodstream (hyperlipidemia)
- Decrease in the level of albumin, which is the main protein responsible for the transport of various substances in the bloodstream (hypoalbuminemia)
- Significant edema formation in areas such as the face, hands and ankles
- Foamy urination
- Weight increase due to water retention in the body
- Weakness
- Loss of appetite
What are the Causes of Nephrotic Syndrome?
Nephrotic syndrome is among the important chronic (long-term) disorders in the pediatric age group. This condition, which can be detected at a rate of 2-7 per 100000 in healthy children under the age of 18, occurs more frequently in boys than in girls. With increasing age, this difference between the sexes decreases. In general, it can be mentioned that nephrotic syndrome occurs more frequently in males. In the remaining patients, various factors such as allergic reaction, insect bite, vaccination or stress are among the underlying causes. can be classified as secondary.
The causes of primary nephrotic syndrome are diseases that only affect the kidney. Focal segmental glomerulosclerosis (FSGS), membranous nephropathy, minimal change disease (glomerulonephritis) and renal vein thrombosis are among the primary causes of nephrotic syndrome.
Focal segmental glomerulosclerosis refers to injury to glomerular structures due to genetic problems or various diseases. In membranous nephropathy, there is a thickening of these glomerular structures. Although the actual cause of this condition is not known exactly, diseases such as lupus, hepatitis b, malaria or cancer may be responsible for the thickening of the glomeruli. Minimal change glomerulonephritis is the first pathology in children among the causes of nephrotic syndrome. This minimal change Intestinal infection, viral infectious diseases, allergic reactions, nonsteroidal anti-inflammatory drugs and the use of some other drugs may also play a role in the emergence of asthma. refers to the blockage of blood clot.
Secondary causes of nephrotic syndrome are disorders affecting the whole body. Diabetes (diabetes), lupus and amyloidosis are among the secondary causes of nephrotic syndrome. High blood sugar levels in diabetics cause damage to the blood vessels. In lupus, an autoimmune disease, there is inflammation in the joints, kidney, and various other organs. Amyloidosis, which is a rare condition, is characterized by the accumulation of the protein called amyloid in various parts of the body. Amyloid deposition may also damage the kidney's filtering system, leading to the development of nephrotic syndrome. Some babies may have a condition called congenital nephrotic syndrome, which occurs in the first 3 months of life. This disorder is thought to be caused by a familial genetic disorder or an infectious disease that occurs shortly after birth. Kidney transplantation may be necessary in the future in children affected in this way.
How is the Diagnosis of Nephrotic Syndrome?
In the first stage of the diagnostic approach to nephrotic syndrome, physicians should review the medical history of patients who apply to health institutions with complaints of this syndrome. performs the acquisition. During the history taking, all symptoms of the person, medications used and other current medical conditions are questioned.
After the history taking, the presence of various symptoms of nephrotic syndrome is examined in the physical examination performed by the physicians. Significant facial edema in the eye area in the early hours of the day and the progression of this edema towards the folds of the skin and joints towards the end of the day are among the classical symptoms in patients with nephrotic syndrome. physical examination Hypertension (high blood pressure) can be detected in approximately 1 in 4 patients during pregnancy. Detection of hypotension (low blood pressure) may indicate that the amount of body fluid in the person has decreased below normal.
Several tests other than physical examination and history taking may be necessary for the diagnosis of nephrotic syndrome:
Urine Tests
Urine tests may be useful in detecting various abnormalities such as high protein leakage. In tests performed with the dipstick method, proteinuria at the nephrotic level is defined by expressions such as +3 and +4. A result of +3 indicates a protein leak of approximately 300 mg per deciliter and above. In this case, there may be a loss of 3 grams of protein daily.
Aside from the dipstick method, 24-hour urine sample can also be collected from the patient. The amount of proteinuria detected in these samples is 3 grams or more, which can be considered among the diagnostic criteria of nephrotic syndrome. Fatty substances can also be detected in the urine of patients with nephrotic syndrome. This condition, called lipiduria, may indicate a glomerular disease. In these patients, serum albumin is typically found to be less than 2.5 grams per deciliter. Apart from albumin, there may be a variability in creatinine levels depending on the level of kidney involvement. Total cholesterol and triglyceride levels are found to be high in patients with nephrotic syndrome. Physicians can get an idea about the structural changes by examining the images of the kidney with this examination.
Kidney Biopsy
A small tissue sample is taken from this organ in the kidney biopsy procedure. The presence of changes that may lead to the development of nephrotic syndrome is investigated in this sample, which is sent to the laboratory for later examination. way is carried out. Physicians when necessary Changes may also be made to various lifestyle practices, such as the medications or dietary habits used by the patient for their current medical conditions.
Children with nephrotic syndrome are generally treated with steroids. Steroid therapy, which is initially started at high doses according to the body surface area, is gradually tapered and terminated within weeks. In cases resistant to steroids, immunological drugs with rituximab active ingredient can be applied.
In addition to these drugs, various blood pressure drugs, diuretics (diuretics), statin group drugs to lower cholesterol level or blood thinners (anticoagulant) drugs may also be included in the treatment.
Making dietary changes in patients with nephrotic syndrome may be very important to prevent progression of kidney damage. With the knowledge and suggestions of physicians and specialist dietitians, various dietary changes that you can make can contribute to keeping this ailment under control. Nephrotic syndrome patients are advised to be careful about the amount of protein and salt they consume in general.
There is an association between nephrotic syndrome and vegetables, which can also be beneficial. White meat, legumes, fresh vegetables and fruits, potatoes, rice, whole wheat products and salt-free snacks are examples of foods that can be included in the nutrition plan of patients with nephrotic syndrome. Processed cheese products, meats with high salt content, canned foods, pickles and junk foods with high salt content are among the foods recommended for nephrotic syndrome patients to stay away from.
The course of nephrotic syndrome may vary depending on the underlying cause. Some causes of nephrotic syndrome may heal spontaneously, while others may worsen and progress to kidney failure, which requires treatment interventions such as dialysis or kidney transplantation. You can ask the expert team of Group Florence Nightingale Hospitals about the subjects you are wondering about
Nephrotic syndrome, and you can ask for suggestions regarding your question. You can use the contact form on our website to reach us.
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