Nephrotic syndrome is a collection of symptoms because of kidneys damage.
Proteinuria – too much protein in your urine, hypoalbuminemia – that is low blood albumin levels, and hyperlipidaemia – high blood lipids, collectively is termed as nephrotic syndrome, irrespective of the causes.
It is usually caused by damage to the clusters of tiny blood vessels (glomeruli) of your kidneys.
The glomeruli filter your blood as it passes through your kidneys, the damaged, glomeruli allow too much blood protein to leave your body, leading to nephrotic syndrome.
COMMON CAUSES
Glomerular causes:
- Minimal change nephropathy – the most common cause of nephrotic syndrome in children results in abnormal kidney function, but when the kidney tissue is examined under a microscope, it appears normal or nearly normal. The cause of the abnormal function typically can’t be determined.
- Proliferative glomerulonephritis.
- Membranous nephropathy – as a result of thickening membranes within the glomeruli. The thickening is due to deposits made by the immune system.
- Focal & segmental glomerulosclerosis – scarring of some of the glomeruli, this condition can result from another disease, a genetic defect or certain medications or occur for no known reason.
- Crescentic glomerulonephritis.
INFECTIONS
- Malaria
- Hepatitis B, C.
- Herpes zoster infections.
- Streptococcal infection.
- Staphylococcus infection.
- Syphilis
- Leprosy
- Cancer
- HIV
FOOD ALLERGIES
- Gluten intolerance.
- Allergy to milk proteins.
- Contaminated foods.
- High intake of meat proteins.
DRUG INDUCED
- Heavy metal like gold therapy.
- Anticonvulsant drugs.
- Non-steroidal anti-inflammatory drugs (NSAID)
- Antibiotics – drugs to fight infections.
- Malignancy:
- Lymphomas & Hodgkin’s disease.
Systemic diseases:
- Diabetes mellitus – Diabetes nephropathy) that affects the glomeruli.
- Systemic lupus erythematosus – chronic inflammatory disease can lead to serious kidney damage.
- SLE
- Amyloidosis – when amyloid proteins accumulate in your organs. Amyloid build-up often damages the kidneys’ filtering system.
- Polyarteritis nodusa. etc
Familial disorders:
- Congenital nephrotic syndrome.
- Fabry’s disease.
Miscellaneous:
- Reflux nephropathy.
- Renal vein thrombosis.
- Toxaemia of pregnancy.
- Allergic reactions to insect bites, pollens, vaccines.
- Renal artery stenosis.
SIGN AND SYMPTOMS
- Severe swelling (oedema), particularly around your eyes and in your ankles and feet
- In children oedema on the face & abdomen.
- Scrotal oedema / Vulvar oedema.
- Bilateral hydrothorax.
- Generalized anasarca.
- Loss of appetite.
- Loss of weight.
- Diarrhea
- Vomiting
- Lethargy, tiredness, fatigue.
- Frequent infections.
- Muscular wasting.
- Dyspnea – shortness of breath
- Increased blood pressure.
- Foamy urine, a result of excess protein in your urine
- Weight gains due to fluid retention
- In later stages hypertension becomes permanent.
- Low blood albumin levels
- High blood lipids.
Further Complications
- 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 pressure. Damage to your glomeruli and the resulting build-up 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.
- 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.
- 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 oedema. You may also have too few red blood cells (anaemia), low blood protein levels and low levels of vitamin D.
- An increased risk of infections.
DIETARY MANAGEMENT
- To prevent oedema, sodium (salt) levels in the diet must be low. Usually, 500mg sodium diet is satisfactory.
- Lots of fresh fruit and vegetables – fibre such as whole grains, fruits and vegetables can help lower total and LDL cholesterol.
- A balanced diet adequate in both energy and protein (1-2gm per kilogram body weight) should be adequate for most children.
- Avoid excessive protein as a very high protein diet may cause tubular damage to the kidneys as the kidneys will have to filter more of the proteins.
- Consume lean cuts of meat, less red meat, more chicken and fish.
- Use healthy oils such as olive, canola, coconut, or sunflower.
- If you are allergic to gluten avoid wheat, rye, barley, oats etc.
- Avoid milk and milk products if you are allergic to milk proteins.
- Avoid proteins like – albumins from eggs and milk, globulin and casein from milk, muscle proteins from meat and soy proteins.
- Avoid artificial body building powders.
- Limit saturated fats (dairy, animal fat) and eliminate trans fat (partially hydrogenated oils found in processed and fast food)
- Avoid animal proteins instead consume plant source of proteins. Limit intake of protein to 40 – 50 gm per day.
- Consume fresh flaxseed oil as they protect kidney from further deterioration and progression to renal failure.
- Increase magnesium intake (300 – 350 mg / day).
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