Nephrotic syndrome

The nephrotic syndrome is a disease of which the expressed proteinuria, hypostases, a lipidemia, a hypoalbuminemia, increase in coagulability of blood, a lipiduriya are characteristic. Owing to various immune disturbances, disbolism, toxic influence, dystrophic processes in an organism occur the changes of walls of glomerular capillaries causing excessive filtering of proteins of plasma. Thus, the acute nephrotic syndrome is a consequence of the morbid conditions resulting in the increased permeability of a wall of glomerular capillaries.

Main reasons for development of a nephrotic syndrome

The huge role in development of a nephrotic syndrome is played by immunologic mechanisms. Are the main reasons for development of primary neurotic syndrome:

• mezangialny proliferative glomerulonephritis;
• hymenoid glomerulonephritis (an idiopathic nephrotic syndrome at adults);
• hymenoid and proliferative glomerulonephritis;
• lipoid nephrosis (a nephropathy with the minimum changes, an idiopathic nephrotic syndrome at children);
• focal and segmented glomerulosclerosis.

The secondary nephrotic syndrome develops as a result:

• infectious diseases (leprosy, secondary syphilis, infectious endocarditis, hepatitis B, etc.);
• toxic and medicinal influences (heavy metals, non-steroidal anti-inflammatory drugs, Penicillaminum, antitoxins, captopril, etc.);
• general diseases of connecting fabric;
• heredo-familial diseases;
• other immune diseases;
• amyloidosis;
• pseudorheumatism;
• drepanocytic anemia;
• diabetes mellitus;
• system lupus erythematosus;
• sarcoidosis;
• tumors (leukosis, lymphoma, melanoma, carcinoma, lymphogranulomatosis);
• Shenleyna-Genokh's diseases.

It should be noted that the nephrotic syndrome at children occurs approximately four times more often than at adults.

Symptoms of a nephrotic syndrome

The main clinical symptom of a nephrotic syndrome are hypostases. Hypostases can gradually develop, but at some patients they arise very quickly. At first they appear in a face, a century, waists and generative organs, and afterwards extend to all hypodermic area, quite often reaching anasarca degree. At patients transsudata in serous cavities are observed: ascites, hydrothorax, hydrocardia. The look at patients becomes pale, with a bloated face and the swelled-up centuries. Despite strong pallor, anemia, as a rule, is absent at all or has moderate character.

If at the patient such symptom of a nephrotic syndrome as a renal failure develops, anemia becomes expressed. At ascites patients complain of digestion disturbance. Patients with a hydrocardia and a hydrothorax have a short wind. From cordial activity the following symptoms of a nephrotic syndrome are noted: emergence of systolic noise over a heart top, a priglushennost of tones, premature ventricular contraction, change of a final part of a ventricular complex, disturbance of a cordial rhythm which in the absence of other heart diseases can be defined as the nephrotic dystrophy of a myocardium resulting from disturbances of metabolism, electrolytic exchange and a hypoproteinemia.

The acute nephrotic syndrome is characterized by sudden manifestation of a proteinuria and hamaturia. Azotemia symptoms develop, there is a delay in an organism of water and salts, arterial hypertension.

Diagnosis of a nephrotic syndrome

Datas of laboratory play a crucial role in diagnosis of a nephrotic syndrome. At a nephrotic syndrome the increased SOE, sometimes to 50-60 mm is watched 1 h. Glomerular filtering, as a rule, normal or is a little increased. The relative density of urine is increased, and its maximum sizes can reach 1030-1060. The urocheras is poor, with the small maintenance of fatty and hyaline cylinders, fatty little bodies. The microhematuria is in certain cases observed. At the acute nephrotic syndrome which developed at patients with a hemorrhagic vasculitis against the background of a glomerulonephritis or a lupoid nephropathy the expressed hamaturia can be observed.

Actually, diagnosis of a nephrotic syndrome does not present special difficulties, and here identification of the main reason can bring to the doctor certain difficulties as the choice of adequate treatment of a nephrotic syndrome depends on it. For the purpose of identification of the reason the doctor can recommend to the patient to undergo full clinical, tool and laboratory inspection.

Current and forecast of a nephrotic syndrome

Many factors define complexity of a current and the forecast of this disease. It and age of patients, disease origin, clinical symptoms, morphological features, existence of complications and adequacy of treatment of a nephrotic syndrome. So, for example, a nephrotic syndrome at children (the lipoid nephrosis has the optimum forecast as it is inclined to remissions and well reacts to corticosteroids.

The forecast at primary hymenoid glomerulonephritis is much worse. As a rule, for the first 10 years at a third of adult patients the chronic renal failure and, as a result, a lethal outcome develops. At primary nephrotic syndrome which resulted from a nephropathy, the forecast is even worse. For 5-10 years at patients the heavy renal failure demanding a hemodialysis or transplantation of a kidney and arterial hypertension develop. The forecast of a secondary nephrotic syndrome is defined by a current and character of a basic disease.

Treatment of a nephrotic syndrome

Patients with this disease have to observe moderate physical activity as the hypokinesia promotes development of thromboses. The electrolyte-deficient diet is appointed, all products which contain sodium are minimized. The volume of the entered liquid should not exceed a daily urine on 20-30 ml. At the normal general caloric content of a diet the patient enters protein at the rate of 1 g on each kilogram of weight. Food has to be vitamin-rich also potassium.

As a rule, at emergence of a renal failure hypostases decrease, then to the patient increase salt volume with the purpose to avoid its deficit, and also allow to accept more liquid. If the azotemia, amount of the entered protein is observed reduce to 0,6 g/kg of body weight a day. Treatment of a nephrotic syndrome albumine reasonablly only at patients with heavy orthostatic hypotension.

At severe hypostases to patients appoint diuretics. Acidum etacrynicum and furosemide which combine with veroshpirony or Triamterenum are most effective.

Recently use of antiagregant and heparin gained distribution at treatment of a nephrotic syndrome that is especially reasonable for the patients inclined to hypercoagulation.