Nephrotic Syndrome

Nephrotic syndrome is a syndrome comprising the following:

• Edema -  swelling of the face, legs, or ankles due to the abnormal collection of fluids in
  the tissues that is usually accompanied by rapid weight gain

• Proteinuria - large amount of protein contained in urine (more than 3 to 3.5g/day) that
  can be identified by frothy or foamy urine in the toilet bowl.

• Hypoalbumina - low level of albumin (less than 30g/L) in the blood
  
  

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​Nephrotic syndrome can be primary, meaning damage is confined to the kidneys alone,
or it can be secondary, meaning organs other than the kidney are also affected.

Primary causes

• Minimal change disease (MCD) is a kidney disease that can occur in both adults and
  children The disease gets its name because the damage to the glomeruli cannot be
  seen under a regular microscope and can only be seen under a powerful microscope
  called an electron microscope
  
  
• Focal segmental glomerulosclerosis (FSGS) is the most common cause of nephrotic
  syndrome in adults. FSGS can cause collapse and scarring of some glomeruli
  Membranous nephropathy (MN) is a condition in which the walls of the glomerular
  blood vessels become thickened

Secondary causes

• Diabetes mellitus causing diabetic kidney disease is common in patients with diabetes
  who have chronically elevated blood glucose levels and/or high blood pressure
  Patients with more advanced disease can develop the nephrotic syndrome
  
  
• Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple
  organs of the body, including the kidney, causing nephrotic syndrome
  

• Urine tests to determine the amount of protein in the urine
  
• Blood tests to assess kidney function, look for auto-antibodies, and other associated conditions such as viral infections
  
• Imaging of the kidneys and other organs if necessary
  
• Kidney biopsy is a procedure done under local anesthesia and guided by ultrasound to obtain a small sample of kidney tissue for microscopic examination
  

Find out more about the kidney biopsy through this link  https://youtu.be/maZtXG-NtV0

​General treatment of the symptoms of nephrotic syndrome

• Diuretics to help get rid of excess water and salt
• Dietary salt restriction
• Medications such as ACE inhibitors or angiotension receptor blockers (ARB) to lower blood pressure, prevent worsening of kidney disease, and reduce the amount of protein excreted in the urine.
• Anticoagulation therapy (Blood thinners) to prevent blood clots if the protein leak is significant.

Acute Treatment

• Immunosuppressant: medication that alter the body’s immune system to reduce the damage to the kidney cells. These medications often have side effects.
  
• Renal replacement therapy in the form of dialysis may be required if the kidney function is severely impaired.

Treating the underlying disease

• Minimal change disease (MCD) almost always responds initially to treatment with
  glucocorticoids (steroids). However, relapses are common, and additional treatment
  with other immunosuppressants may be required to maintain remission.

• Focal segmental glomerulosclerosis (FSGS) can be classified as primary FSGS or
  Secondary FSGS The treatment of primary FSGS is similar to MCD Secondary FSGS is
  treated primarily with ACE inhibitors or ARBs.
  
• Membranous nephropathy (MN) for patients with mild symptoms, a period of
  “watch and wait” is recommended initially to determine if the condition is worsening
  or causing complications Immunosuppressive treatment is generally held off for a
  period of about 6 months until/unless symptoms worsen However if the patient has
  severe symptoms from the start or if the condition progresses while under monitoring,
  treatment should be started.
  
• Diabetes mellitus  - Management includes intensive management of blood sugar
  levels, cholesterol, and blood pressure.
  
• Lupus -Patients with lupus who have nephrotic syndrome or evidence of worsening
  kidney function can be treated with steroids and immunosuppressants.