Consider this is a nephrotic syndrome. This is a complex of symptoms that develops with kidney damage and includes massive proteinuria, swelling and impaired protein and lipid metabolism. The pathological process is accompanied by dysproteinemia, hyperlipidemia, hypoalbuminemia, edema of different localization (up to dropsy of serous cavities), dystrophic changes in the mucous membranes and skin. In the diagnosis, the clinical and laboratory picture play an important role: extrarenal and renal symptoms, changes in the biochemical analysis of blood and urine, and kidney biopsy data. Therapy for nephrotic syndrome is usually conservative. It includes the appointment of diuretics, diets, infusion therapy, corticosteroids, antibiotics, cytostatics.
Acute nephrotic syndrome often occurs against a background of a wide range of systemic, urological, infectious, chronic metabolic, suppurative diseases. In modern urology, this symptom complex significantly complicates the course of kidney diseases, which is observed in approximately 20% of cases. The disease most often develops in adult patients after 30, less often in older people and in children. At the same time, a classical tetrad of laboratory signs is noted: proteinuria (more than 3.5 g / day), hypoproteinemia and hypoalbuminemia (less than 60-50 g / l), hyperlipidemia (cholesterol level more than 6.5 mmol / l), swelling. In the absence of some of these manifestations, experts speak of a reduced nephrotic syndrome (incomplete). The causes of nephrotic syndrome are discussed below.
Causes of occurrence
To understand that this is a nephrotic syndrome, we will find out the causes of the disease. By the nature of its origin, the ailment is primary (complicating independent pathologies of the kidneys) and secondary (as a result of diseases involving secondary kidneys). Primary pathology occurs with pyelonephritis, glomerulonephritis, primary amyloidosis, kidney tumors (hypernephroma), and nephropathy in pregnant women. In addition, nephrotic syndrome is congenital, and in this case, the pathology is due to hereditary factors and the characteristics of the course of the pregnancy period.
What is the cause of the secondary symptom complex?
The secondary symptom complex is often caused by numerous pathological conditions:
- rheumatic lesions and collagenoses (SLE, hemorrhagic vasculitis, periarteritis nodosa, rheumatism, scleroderma, rheumatoid arthritis);
- suppuration processes (lung abscesses, bronchiectasis, septic endocarditis);
- diseases of the lymphatic system (lymphogranulomatosis, lymphoma);
- parasitic and infectious diseases (malaria, tuberculosis, syphilis).
In many cases, nephrotic syndrome occurs against the background of drug treatment, with severe allergies, poisoning with heavy metals (lead, mercury), bee and snake bites. In children, the cause of the disease often cannot be identified, therefore, doctors also distinguish an idiopathic version of the pathological process. What are the differences between nephrotic syndrome and other kidney ailments?
Pathogenesis
Among the concepts of pathogenesis, the most justified and widespread is the immunological theory. The frequency of occurrence of this syndrome in autoimmune and allergic diseases and the good response of the body to immunosuppressive treatment testify to its benefit. Moreover, immune circulating complexes formed in the blood are the result of the interaction of antibodies and internal (DNA, cryoglobulins, denatured nucleoproteins, proteins) or external (viral, bacterial, food, drug) antigens. These are the main criteria for nephrotic syndrome.
In some cases, antibodies directly form to the basement membrane of the glomeruli of the kidneys. The deposition of immune complexes in the tissues of the kidneys provokes an inflammatory reaction, disrupts microcirculation in the glomerular capillaries, and contributes to the development of excessive intravascular coagulation. Violation of the permeability of glomerular filters with nephrotic syndrome leads to disruption of the absorption of the protein and its penetration into the urine (proteinuria).
Given the massive loss of proteins in the blood, hypoalbuminemia, hypoproteinemia and hyperlipidemia (an increase in triglycerides, cholesterol and phospholipids) are closely associated with similar protein metabolism disorders. The development of edema is caused by hypoalbuminemia, hypovolemia, a decrease in osmotic pressure, a deterioration in renal blood flow, pronounced production of renin and aldosterone, and sodium reabsorption.
The kidneys with nephrotic syndrome have macroscopically increased dimensions, a flat and smooth surface. In the section, the cortical layer has a pale gray tint, and the brain layer is reddish. Microscopic examination of the tissue picture of the kidneys allows you to visualize the changes that characterize not only nephrotic syndrome, but also the main pathology (glomerulonephritis, amyloidosis, tuberculosis, collagenosis). In histological terms, nephrotic syndrome is characterized by a violation of the structure of the basement membranes of capillaries and podocytes (glomerular capsule cells).
Symptoms
Many patients do not even realize that this is a nephrotic syndrome. The main manifestations of the disease, as a rule, are of the same type, despite the difference in the causes that provoke it. The leading symptom is proteinuria, which reaches 3.5-5 or more g / day. Approximately 90% of the protein excreted in the urine is albumin. A powerful loss of protein compounds provokes a decrease in the total concentration of whey protein to 60-40 g / l or more. Fluid retention is manifested by ascites, peripheral edema, anasarca (generalized edema of the subcutaneous tissue), hydropericardium, hydrothorax. Signs of nephrotic syndrome are rather unpleasant.
The progression of this pathological process is accompanied by severe weakness, thirst, dry mouth, loss of appetite, headaches, heaviness in the lower back, bloating, vomiting, and diarrhea. Another characteristic feature is polyguria, in which the daily diuresis is less than 1 liter. The occurrence of paresthesia, myalgia, and convulsions is also possible. The development of hydropericardium and hydrothorax also provokes shortness of breath at rest and during movement. Peripheral edema significantly limits the patient's motor activity. He has immobility, pallor, increased dryness and peeling of the skin, brittle nails and hair.
The disease nephrotic syndrome develops violently or gradually, and is accompanied by more or less severe symptoms, which mainly depends on the nature of the underlying pathology. According to the clinical course, two variants of the disease should be distinguished - mixed and pure. In the first case, it can take a nephrotic-hypertonic or nephrotic-hematuric form, and in the second, the syndrome proceeds without hypertension and hematuria.
Congenital type
Congenital nephrotic syndrome is a serious pathology found in children. It is characterized by a generalized form of swelling (spreading throughout the body), hyperlipidemia, and proteinuria. At the heart of the development of this disease is a kidney pathology of a hereditary nature.
Depending on the reasons that provoke nephrotic syndrome, several of its varieties are distinguished, and different treatment methods are applicable for each form. These types of congenital disease are:
- Secondary syndrome, which is a side effect of various systemic pathologies in children. For example, lupus erythematosus, diabetes mellitus, circulatory system disorders, cancer, viral liver damage. The prognosis, course of the disease, and the choice of treatment method for this form depend on the severity of the pathological process and the severity of the clinical symptoms.
- Hereditary Syndrome. This form quickly manifests itself in children after their birth. In some cases, this diagnosis is determined even during the intrauterine development of the baby. However, there are cases when nephrotic syndrome manifests itself at an older age (for example, in the school period). In any case, such a pathology is very difficult to treat. Most patients develop kidney failure.
- Idiopathic syndrome. It is diagnosed in the case when it was not possible to establish the exact cause of the disease.
- Tubulointerstitial syndrome. With this form of nephrotic syndrome, the kidneys are affected in such a way that their level of functioning decreases. There are acute and chronic types of ailment. The first is most often triggered by taking medications or allergic reactions to them. In addition, an infectious agent is a common cause. The chronic type develops, as a rule, against the background of other diseases.
Symptoms of the interstitial form of the syndrome in children, as with other varieties of this ailment, are usually noticeable immediately. It is necessary to pay special attention to the following pathological phenomena:
- Swelling of the body progresses rapidly. It first appears on the eyelids, then goes to the stomach, legs, groin. In the future, ascites develops.
- The distribution of fluid in the body often depends on the position of the child’s body. This also affects puffiness. For example, if a child is standing for some time, his legs swell.
- The amount of urine released is gradually reduced. This affects the performance of laboratory tests, as the level of protein in the urine increases.
Initially, the child has an increase in blood pressure. It becomes lethargic, irritable, there is a headache and other symptoms of this condition. If this sick state of health is ignored for a long time, the child develops kidney failure.
Infectious diseases are extremely dangerous for children with nephrotic syndrome. In the body, pneumococcus or streptococcus can be activated, so serious diseases can occur as consequences. It can be bronchitis, and erysipelas, and peritonitis. We will find out how glomerulonephritis and nephrotic syndrome are related. It is the same?
Glomerulonephritis as a cause of pathology
Glomerulonephritis is characterized by an immune inflammatory lesion of the kidneys. In most cases, the onset of this disease is due to an increased immune response to infectious antigens. In addition, an autoimmune form of pathology is known when kidney damage occurs due to the destructive effects of autoantibodies (antibodies to own cells).
The disease ranks second among secondary kidney pathologies in children after urinary tract infections. According to statistics, pathology is the most common cause of early disability of patients due to the development of kidney failure. The development of acute glomerulonephritis and nephrotic syndrome is observed at any age, but most often the disease occurs in people under 40 years old.
The cause is usually a chronic or acute streptococcal infection (pneumonia, tonsillitis, tonsillitis, streptoderma, scarlet fever). The disease can occur as a result of chickenpox, measles or SARS. The risk of a pathological condition increases with prolonged exposure to cold in high humidity (called "trench" nephrite), since a combination of such external factors changes the immunological response and contributes to a violation of the blood supply to the kidneys.
Diagnostic measures
The main criteria for the diagnosis of nephrotic syndrome are clinical and laboratory information. An objective examination helps to identify pale (“pearlescent”), dry and cold to the touch skin, an increase in the size of the abdomen, the lining of the tongue, hepatomegaly, swelling. With hydropericardium, there is an expansion of the borders of the heart, a muffling of tones. With the development of hydrothorax - shortening of percussion sound, congestive small bubbling rales, weakened breathing. On the ECG, signs of myocardial dystrophy are noted, bradycardia is recorded.
Nephrotic Syndrome Treatment
Therapy of this pathology is carried out in stationary conditions under the supervision of a nephrologist. The general measures that do not depend on the nature of the origin of the nephrotic syndrome are the appointment of a salt-free diet with a limited amount of fluid, symptomatic drug therapy (potassium preparations, diuretics, antihistamines, heart remedies, vitamins, heparin, antibiotics), bed rest, albumin infusion, reopoliglyukin .
What else does treatment for nephrotic syndrome suggest?
In the unclear genesis of the disease, in a condition caused by autoimmune or toxic kidney damage, patients are shown steroid treatment with methylprednisolone or prednisolone (orally or intravenously by pulse therapy). Immunosuppressive steroid treatment helps to suppress the formation of antibodies, CEC, normalizes glomerular filtration and renal blood flow. Cytostatic therapy with chlorambucil and cyclophosphamide, which is carried out by pulse courses, allows a good effect of the treatment of a hormone-resistant variant of the disease. During remission, treatment at climatic resorts is recommended. All recommendations for nephrotic syndrome should be strictly followed.
Diet
With the development of this pathology, the patient should follow a special diet. It is prescribed for patients who have pronounced swelling, with the ability of the kidneys to filter. Dietary nutrition also largely depends on the level of protein in the urine.
With a diagnosis of nephrotic syndrome, diet implies compliance with the following recommendations:
- eat food 5 to 6 times a day in small portions;
- you can not eat more than 3000 calories;
- spicy and fatty foods are prohibited;
- Do not consume more than 4 g of salt per day;
- drink at least 1 liter of fluid per day.
A large number of fruits and vegetables, as well as pasta, cereals, stewed fruits, low-fat varieties of fish and meat, bran bread, are also recommended for consumption.
Prevention and prognosis
The course and prognosis are associated with the nature and causes of the development of the underlying pathology. In general, the suppression of etiological factors, the correct and timely treatment can restore the functionality of the kidneys and achieve stable remission. With unresolved causes, the nephrotic syndrome often takes a relapsing or persistent course with a transition to chronic kidney failure.
Prevention of this disease includes early and enhanced treatment of extrarenal or renal pathology, which may be complicated by the occurrence of nephrotic syndrome, the controlled and careful use of medications that have allergic and nephrotoxic effects. In any case, if symptoms of this pathology occur, a timely visit to the doctor is recommended.
We considered that it is a nephrotic syndrome.