Nephrosis

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Overview

Nephrotic syndrome (NS) is a clinical syndrome defined by massive proteinuria responsible for hypoalbuminemia, with resulting hyperlipidemia, edema, and various complications. It is caused by increased permeability through the damaged basement membrane in the renal glomerulus, especially infectious or thrombo-embolic. It results from an abnormality of glomerular permeability that may be primarily due to an intrinsic renal disease in the kidneys or secondary due to congenital infections, diabetes, systemic lupus erythematosus, neoplasia, or certain drug use. Nephrotic-range proteinuria is defined as the urinary loss of 3 grams or more of proteins per 24 hours or, on a single spot urine sample, the presence of 2 g of protein per gram of urinary creatinine. This proteinuria can also result from other systemic diseases, such as amyloidosis.

The disorder can affect people of all ages. In most children, the first sign of nephrotic syndrome is facial swelling. Adults usually present with dependent edema.

The nephrotic syndrome could affect adults and children of both genders and any race. Also, it could occur in a typical form or with nephritic syndrome. The latter denotes glomerular inflammation leading to hematuria and impaired renal function.

The first indication of nephrotic syndrome in children is the swelling of the face which then progresses to the entire body. Adults may present with dependent edema. Other common features are fatigue and loss of appetite.

Symptoms

Severe swelling (edema), particularly around your eyes and in your ankles and feet.

Foamy urine, a result of excess protein in your urine.

Weight gain due to fluid retention.

Fatigue.

Loss of appetite.

Causes

Your kidneys are filled with tiny blood vessels called glomeruli. As your blood moves through these vessels, extra water and waste products are filtered into your urine. Protein and other substances that your body needs stay in your bloodstream.

Nephrotic syndrome happens when the glomeruli are damaged and can’t properly filter your blood. Damage to these blood vessels allows protein to leak into your urine.

Albumin is one of the proteins lost in your urine. Albumin helps pull extra fluid from your body into your kidneys. This fluid is then removed in your urine.

Without albumin, your body holds on to the extra fluid. This causes swelling (edema) in your legs, feet, ankles, and face.

Risk factors

There are some things that can put you at an increased risk of developing nephrotic syndrome. These can include:

An underlying condition that can lead to kidney damage. Examples of such conditions include things like diabetes, lupus, or other kidney diseases.

Specific infections. There are some infections that may increase your risk of nephrotic syndrome, including HIV, hepatitis B and C, and malaria.

Medications. Some infection-fighting drugs and NSAIDs can increase the risk of nephrotic syndrome.

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Complications

Possible complications of nephrotic syndrome include:

Blood clots. The inability of the glomeruli to filter blood properly can lead to loss of blood proteins that help prevent clotting. This increases your risk of developing a blood clot in your veins.

High blood cholesterol and elevated blood triglycerides. When the level of the protein albumin in your blood falls, your liver makes more albumin. At the same time, your liver releases more cholesterol and triglycerides.

Poor nutrition. Loss of too much blood protein can result in malnutrition. This can lead to weight loss, which can be masked by edema. You may also have too few red blood cells (anemia), low blood protein levels and low levels of vitamin D.

High blood pressure. Damage to your glomeruli and the resulting buildup of excess body fluid can raise your blood pressure.

Acute kidney injury. If your kidneys lose their ability to filter blood due to damage to the glomeruli, waste products can build up quickly in your blood. If this happens, you might need emergency dialysis — an artificial means of removing extra fluids and waste from your blood — typically with an artificial kidney machine (dialyzer).

Chronic kidney disease. Nephrotic syndrome can cause your kidneys to lose their function over time. If kidney function falls low enough, you might need dialysis or a kidney transplant.

Infections. People with nephrotic syndrome have an increased risk of infections.

Prevention

You can't prevent some causes of nephrotic syndrome. But you can take action to avoid damage to your glomeruli: Manage high blood pressure and diabetes, if you have them. Be sure to get vaccines for common infections, especially if you work around people who have hepatitis or other diseases.