Nephrotic syndrome is a disease characterized by severe proteinuria, edema, hyperlipidemia, hypoalbuminemia, increased blood clotting, lipiduria. Due to various immune disorders, metabolic disorders, toxic effects, dystrophic processes in the body, changes in the walls of the glomerular capillaries occur, causing excessive filtration of plasma proteins. Thus, acute nephrotic syndrome is a consequence of pathological conditions leading to increased permeability of the glomerular capillary wall, according to Pannochka, an Internet publication for girls and women from 14 to 35 years old.. net The main causes of the development of nephrotic syndrome Immunological mechanisms play a huge role in the development of nephrotic syndrome. The main reasons for the development of primary neurotic syndrome are:.

mesangial proliferative glomerulonephritis;

membranous glomerulonephritis (idiopathic nephrotic syndrome in adults);

membranoproliferative glomerulonephritis;

lipoid nephrosis (minimal change nephropathy, idiopathic nephrotic syndrome in children);

focal segmental glomerulosclerosis.

Secondary nephrotic syndrome develops as a result of:.

infectious diseases (leprosy, secondary syphilis, infective endocarditis, hepatitis B, etc..

toxic and drug effects (heavy metals, non-steroidal anti-inflammatory drugs, penicillamine, antitoxins, captopril, etc.).

systemic connective tissue diseases;

family hereditary diseases;

other immune diseases;

amyloidosis;

rheumatoid arthritis;

sickle cell anemia;

diabetes mellitus;

systemic lupus erythematosus;

sarcoidosis;

tumors (leukemia, lymphoma, melanoma, carcinoma, lymphogranulomatosis);

Schonlein-Henoch disease.

It should be noted that nephrotic syndrome occurs about four times more often in children than in adults..

Symptoms of nephrotic syndrome The main clinical symptom of nephrotic syndrome is edema.. Swelling can develop gradually, but in some patients, it occurs very quickly. First, they appear in the area of \u200b\u200bthe face, eyelids, lower back and genitals, and subsequently spread to the entire subcutaneous region, often reaching the degree of anasarca. Patients have transudates into serous cavities: ascites, hydrothorax, hydropericardium. Patients appear pale, with a puffy face and swollen eyelids.. Despite severe pallor, anemia is usually absent or mild.

If a patient develops a symptom of nephrotic syndrome such as renal failure, anemia becomes severe. With ascites, patients complain of indigestion. Shortness of breath appears in patients with hydropericardium and hydrothorax. On the part of the cardiac activity, the following symptoms of nephrotic syndrome are noted: the appearance of a systolic murmur over the apex of the heart, muffled tones, extrasystole, a change in the end part of the ventricular complex, heart rhythm disturbances, which, in the absence of other heart diseases, can be defined as nephrotic myocardial dystrophy resulting from metabolic disturbances.

Acute nephrotic syndrome is characterized by sudden onset of proteinuria and hematuria. Symptoms of azotemia develop, there is a retention of water and salts in the body, arterial hypertension.

Diagnosis of Nephrotic Syndrome Laboratory findings play a critical role in the diagnosis of nephrotic syndrome. With nephrotic syndrome, an increased ESR is observed, sometimes up to 50-60 mm in 1 hour. Glomerular filtration is usually normal or slightly increased. The relative density of urine is increased, and its maximum values \u200b\u200bcan reach 1030-1060. Urine sediment is scanty, with a small content of fatty and hyaline casts, fatty bodies. In some cases, microhematuria is observed. In acute nephrotic syndrome that develops in patients with hemorrhagic vasculitis, severe hematuria may be observed against the background of glomerulonephritis or lupus nephropathy.

Actually, the diagnosis of nephrotic syndrome itself does not present any particular difficulties, but the identification of the main cause can give the doctor certain difficulties, since the choice of an adequate treatment for nephrotic syndrome depends on it.. In order to identify the cause, the doctor may recommend that the patient undergo a complete clinical, instrumental and laboratory examination..

The course and prognosis of nephrotic syndrome Many factors determine the complexity of the course and prognosis of this disease. This is the age of patients, the cause of the disease, clinical symptoms, morphological signs, the presence of complications and the adequacy of the treatment of nephrotic syndrome.. For example, nephrotic syndrome in children (lipoid nephrosis has the most favorable prognosis, as it is prone to remission and responds well to corticosteroids.

The prognosis for primary membranous glomerulonephritis is much worse. As a rule, during the first 10 years, one third of adult patients develop chronic renal failure and, as a result, death.. In primary nephrotic syndrome resulting from nephropathy, the prognosis is even worse. Over the course of 5-10 years, patients develop severe renal failure requiring hemodialysis or kidney transplantation, and hypertension. The prognosis of secondary nephrotic syndrome is determined by the course and nature of the underlying disease.

Treatment of nephrotic syndrome Patients with this disease should observe moderate physical activity, since hypokinesia contributes to the development of thrombosis. A salt-free diet is prescribed, all foods that contain sodium are minimized. The volume of injected fluid should not exceed the daily urine output by 20-30 ml. With a normal total calorie intake, patients are injected with protein at the rate of 1 g per kilogram of weight. Food should be rich in vitamins and potassium.

As a rule, when renal failure appears, the edema decreases, then the patient is increased the volume of salt in order to avoid its deficiency, and also allowed to take more fluids. If azotemia is observed, the amount of injected protein is reduced to 0.6 g / kg of body weight per day.

Treatment of nephrotic syndrome with albumin is advisable only in patients with severe orthostatic hypotension.

For severe edema, patients are prescribed diuretics. The most effective are ethacrynic acid and furosemide, which are combined with verospiron or triamterene.

Recently, the use of antiplatelet agents and heparin has become widespread in the treatment of nephrotic syndrome, which is especially advisable for patients prone to hypercoagulability..

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