Nephrotic syndrome (NS)

• What is Nephrotic Syndrome (NS)
• Statistics on Nephrotic Syndrome (NS)
• Risk Factors for Nephrotic Syndrome (NS)
• Progression of Nephrotic Syndrome (NS)
• Symptoms of Nephrotic Syndrome (NS)
• Clinical Examination of Nephrotic Syndrome (NS)
• How is Nephrotic Syndrome (NS) Diagnosed?
• Prognosis of Nephrotic Syndrome (NS)
• How is Nephrotic Syndrome (NS) Treated?
• Nephrotic Syndrome (NS) References

What is Nephrotic Syndrome (NS)

Nephrotic Syndrome (NS) is a disease affecting the kidneys.

Exclusively associated with the excessive loss of albumin into the urine generally defined to be exceeding 3.5g per day.

Statistics on Nephrotic Syndrome (NS)

Difficult to estimate due to wide cross section of renal disorders being associated with its occurrence. Minimal change disease accounts for three quarters of childhood cases and this occurs in 15 per 100,000 children. The incidence in adults is also dependent on the cause and thus will vary with the incidence of the particular diseases in the population.

Risk Factors for Nephrotic Syndrome (NS)

Nephrotic syndrome has a vast number of causes.

They are classified as primary (causes that primarily affect the glomerulus of the kidney) and secondary (known conditions whose affect on the kidney is part of their spectrum of disease. The primary causes are designated according to their microscopic appearance, for little is known about their specific origin. The secondary causes are designated by disease name, for the nephrotic syndrome occurs with the existence of that disease.

The primary diseases include minimal change disease, focal segmental glomerulosclerosis, membranous glomerulopathy, proliferative glomerulonephritis and membranoproliferative glomerulonephritis.

The secondary diseases include various infections, drugs/toxins (non-steroidal anti-inflammatories, gold salts, heroin, heavy metals, bee stings, pollens, tumour associated antigens), collagen-vascular diseases, diabetes mellitus, amyloidosis, light chain nephropathy, chronic vesicoureteric reflux, pregnancy, and obesity.

Progression of Nephrotic Syndrome (NS)

Prior to the development of immunosuppression therapy, nephrotic syndrome resolved in one of three ways.

1. Patients experienced the complications of nephrosis: Immunoglobulin loss in the urinary protein increased susceptibility to infection. The balance of clotting factors in the blood is also altered by this condition increasing the risk of developing clots in affected patients.

2. Renal toxicity: The longer and greater the loss of protein in the urine, the quicker the kidney develops glomerulosclerosis and fails.

3. The development of chronic renal failure.

Careful attention to the glomerulopathy with steroids and to the complications with drugs such as angiotensin converting enzyme inhibitors have substantially improved the prognosis and prolonged the functional life of the kidney.

How is Nephrotic Syndrome (NS) Diagnosed?

The diagnosis of nephrotic syndrome will require a number of blood and urine tests to be carried out. Typical findings are increased protein in the urine, (which may need to be quantified with a 24 hr urine collection) decreased proteins in the blood and increased lipids or fats within the bloodstream.

Prognosis of Nephrotic Syndrome (NS)

The outcome varies; the syndrome may be acute and short-term or chronic and unresponsive to therapy. The cause and development of complications also affects the outcome.

How is Nephrotic Syndrome (NS) Treated?

1. Reduction of oedema: This can be achieved with the use of fluid tablets such as frusemide to enable the kidneys to excrete excess fluid more rapidly.

2. Control of hypertension: With sietary salt reduction and anti-hypertensive medication.

3. Prevention of infection: The pneumococcal vaccine is usually given as patients with this condition are more susceptible to this kind of infection.

4. Vitamin D supplementation: If deemed required on blood examination.

5. Prevent blood clots: Consider anticoagulation therapy.

6. Steroid therapy: May be necessary in some cases to control the condition.

Nephrotic Syndrome (NS) References

[1] Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison’s Principles of Internal Medicine. 15th Edition. McGraw-Hill. 2001.
[2] Cotran, Kumar, Collins 6th edition. Robbins Pathologic Basis of Disease. WB Saunders Company. 1999.
[3] Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002 Pg 427-430.
[4] Hurst JW (Editor-in-chief). Medicine for the practicing physician. 4th edition Appleton and Lange 1996.
[5] Longmore M, Wilkinson I, Torok E. OXFORD HANDBOOK OF CLINICAL MEDICINE. Oxford Universtiy Press. 2001.
[6] MEDLINE Plus.