Consider that this is a nephrotic syndrome. This is a complex of symptoms that develops with kidney damage and includes massive proteinuria, edema, and impaired protein and lipid metabolism. The pathological process is accompanied by dysproteinemia, hyperlipidemia, hypoalbuminemia, edema of different localization (up to dropsy of serous cavities), dystrophic changes in the mucous membranes and skin. In the diagnosis, the most important role is played by the clinical and laboratory picture: extrarenal and renal symptoms, changes in the biochemical analysis of blood and urine, kidney biopsy data. Therapy for nephrotic syndrome is usually conservative. It includes the appointment of diuretics, diet, fluid therapy, corticosteroids, antibiotics, cytostatics.
Acute nephrotic syndrome often occurs with a wide range ofsystemic, urological, infectious, chronic metabolic, suppurative diseases. In modern urology, such a symptom complex significantly complicates the course of kidney diseases, which is observed in approximately 20% of cases. The disease most often develops in adult patients after 30, less often in older people and in children. At the same time, there is a classic tetrad of laboratory signs: proteinuria (more than 3.5 g / day), hypoproteinemia and hypoalbuminemia (less than 60-50 g / l), hyperlipidemia (cholesterol level more than 6.5 mmol / l), swelling. In the absence of some of these manifestations, experts speak of a reduced nephrotic syndrome (incomplete). The causes of nephrotic syndrome will be considered further.
Causes of occurrence
To understand what it is - nephrotic syndrome, find out the causes of the disease. By the nature of its origin, the disease is primary (complicating independent pathologies of the kidneys) and secondary (as a result of diseases that occur with the involvement of the kidneys of a secondary nature). Primary pathology occurs with pyelonephritis, glomerulonephritis, primary amyloidosis, kidney tumors (hypernephroma), nephropathy of pregnant women. In addition, nephrotic syndrome is congenital, and in this case, the pathology is due to hereditary factors and the characteristics of the course of the pregnancy period.
What causes the secondary symptom complex?
Secondary symptom complex is often caused by numerous pathological conditions:
- rheumatic lesions and collagenoses (SLE, hemorrhagic vasculitis, nodularperiarteritis, rheumatism, scleroderma, rheumatoid arthritis);
- suppuration processes (lung abscesses, bronchiectasis, septic endocarditis);
- diseases of the lymphatic system (lymphogranulomatosis, lymphoma);
- parasitic and infectious diseases (malaria, tuberculosis, syphilis).
In many cases, nephrotic syndrome occurs against the background of drug treatment, with severe allergies, heavy metal poisoning (lead, mercury), bee and snake stings. In children, the cause of the development of the disease often cannot be identified, so doctors also distinguish an idiopathic variant of the pathological process. How is nephrotic syndrome different from other kidney disorders?
Pathogenesis
Among the concepts of pathogenesis, the most reasonable and widespread is the immunological theory. In its favor is the frequency of occurrence of this syndrome in autoimmune and allergic diseases and the good response of the body to immunosuppressive treatment. In this case, the immune circulating complexes formed in the blood are the result of the interaction of antibodies and internal (DNA, cryoglobulins, denatured nucleoproteins, proteins) or external (viral, bacterial, food, drug) antigens. These are the main criteria for nephrotic syndrome.
In some cases, antibodies are directly formed against the basement membrane of the glomeruli of the kidneys. The deposition of immune complexes in the tissues of the kidneys provokes an inflammatory reaction, disruptsmicrocirculation in the glomerular capillaries, contributes to the development of excessive intravascular coagulation. Violation of the permeability of the glomerular filters in nephrotic syndrome leads to impaired protein absorption and its penetration into the urine (proteinuria).
Given the massive loss of proteins in the blood, hypoalbuminemia, hypoproteinemia and hyperlipidemia (increased levels of triglycerides, cholesterol and phospholipids), closely associated with such disorders of protein metabolism, develop. The development of edema is due to hypoalbuminemia, hypovolemia, a decrease in osmotic pressure, deterioration of renal blood flow, pronounced production of renin and aldosterone, and sodium reabsorption.
Kidneys in nephrotic syndrome are macroscopically enlarged, flat and smooth surface. On section, the cortical layer has a pale gray tint, and the medulla is reddish. Microscopic examination of the tissue picture of the kidneys allows you to visualize the changes that characterize not only the nephrotic syndrome, but also the underlying pathology (glomerulonephritis, amyloidosis, tuberculosis, collagenoses). Histologically, nephrotic syndrome is characterized by a violation of the structure of the basement membranes of capillaries and podocytes (cells of the glomerular capsule).
Symptoms
Many patients do not even realize that this is a nephrotic syndrome. The main manifestations of the disease, as a rule, are of the same type, despite the existing difference in the causes provoking it. The leading symptom is proteinuria, which reaches 3.5-5 or more g/day. Approximately 90% of the protein excreted fromurine, make up albumins. A powerful loss of protein compounds provokes a decrease in the total concentration of whey protein to 60-40 g / l or more. Fluid retention is manifested by ascites, peripheral edema, anasarca (generalized swelling of the subcutaneous tissue), hydropericardium, hydrothorax. The signs of nephrotic syndrome are rather unpleasant.
The progression of this pathological process is accompanied by severe weakness, thirst, dry mouth, loss of appetite, headaches, heaviness in the lower back, bloating, vomiting, diarrhea. Another characteristic feature is polyguria, in which the daily diuresis is less than 1 liter. It is also possible the occurrence of phenomena of paresthesia, myalgia, convulsions. The development of hydropericardium and hydrothorax and provokes shortness of breath at rest and during movement. Peripheral edema significantly limits the patient's motor activity. He has inactivity, pallor, increased dryness and peeling of the skin, brittle nails and hair.
Disease nephrotic syndrome develops rapidly or gradually, and is accompanied by more or less pronounced symptoms, which mainly depends on the nature of the course of the underlying pathology. According to the clinical course, two variants of the disease should be distinguished - mixed and pure. In the first case, it can take a nephrotic-hypertonic or nephrotic-hematuric form, and in the second, the syndrome proceeds without hypertension and hematuria.
Innate type
Congenital nephrotic syndrome isserious pathology found in children. It is characterized by a generalized form of edema (spread throughout the body), hyperlipidemia, and proteinuria. At the heart of the development of this disease is the pathology of the kidneys of a hereditary nature.
Depending on the causes that provoke nephrotic syndrome, several of its varieties are distinguished, and different methods of treatment are applicable for each form. These types of congenital diseases are:
- Secondary syndrome, which is a side effect of various systemic pathologies in children. For example, lupus erythematosus, diabetes mellitus, disorders of the circulatory system, cancer, viral liver damage. The prognosis, course of the disease and the choice of the method of therapy for this form depend on the severity of the pathological process and the severity of clinical symptoms.
- Hereditary syndrome. This form quickly manifests itself in children after their birth. In some cases, this diagnosis is determined even during the intrauterine development of the baby. However, there are cases when nephrotic syndrome manifests itself already at an older age (for example, during the school period). In any case, such a pathology is very difficult to treat. Most patients develop kidney failure.
- Idiopathic syndrome. It is diagnosed in the case when it was not possible to determine the exact cause of the disease.
- Tubulointerstitial syndrome. In this form of nephrotic syndrome, the kidneys are affected in such a way that their level of functioning is reduced. There are sharp andchronic types of illness. The first is most often provoked by taking medications or allergic reactions to them. In addition, an infectious agent is a common cause. The chronic type develops, as a rule, against the background of other diseases.
Symptoms of the interstitial form of the syndrome in children, as in other varieties of this disease, are usually noticeable immediately. Pay special attention to the following pathological phenomena:
- Puffiness of the body progresses rapidly. She first appears on the eyelids, then goes to the stomach, legs, groin. Later, ascites develops.
- The distribution of fluid in the body often depends on the position of the child's body. It also affects puffiness. For example, if a child has been standing for a while, his legs will swell.
- The amount of urine excreted gradually decreases. This affects lab results as it increases protein levels in the urine.
At first, the child has an increase in blood pressure. He becomes lethargic, irritable, has a headache and other symptoms of this condition. If this painful state of he alth is ignored for a long time, the child develops kidney failure.
Infectious diseases are extremely dangerous for children with nephrotic syndrome. Pneumococcus or streptococcus can become activated in the body, so serious diseases can occur as consequences. It can be bronchitis, and erysipelas, and peritonitis. Find out how glomerulonephritis andnephrotic syndrome. Is it the same thing?
Glomerulonephritis as a cause of pathology
Glomerulonephritis is characterized by an immune-inflammatory lesion of the kidneys. In most cases, the onset of this disease is due to an increased immune response to infectious antigens. In addition, an autoimmune form of pathology is known, when kidney damage occurs due to the destructive effects of autoantibodies (antibodies to one's own cells).
The disease ranks second among the secondary pathologies of the kidneys in children after an infectious lesion of the urinary tract. According to statistics, pathology is the most common cause of early disability of patients due to the development of kidney failure. The development of acute glomerulonephritis and nephrotic syndrome is observed at any age, but most often the disease occurs in people under 40.
The cause is usually a chronic or acute streptococcal infection (pneumonia, tonsillitis, tonsillitis, streptoderma, scarlet fever). The disease can occur as a result of chicken pox, measles or SARS. The risk of developing a pathological condition increases with prolonged exposure to cold with high humidity (has the name "trench" nephritis), since the combination of such external factors changes immunological reactions and contributes to impaired blood supply to the kidneys.
Diagnostic measures
The main criteria for the diagnosis of nephrotic syndrome are clinical and laboratory information. Objective examination helps to identifypale ("pearl"), dry and cold to the touch skin, an increase in the size of the abdomen, tongue fur, hepatomegaly, swelling. With hydropericardium, there is an expansion of the boundaries of the heart, muffled tones. With the development of hydrothorax - shortening of percussion sound, congestive fine bubbling rales, weakened breathing. The ECG shows signs of myocardial dystrophy, bradycardia is recorded.
Treatment of nephrotic syndrome
Therapy of this pathology is carried out in a hospital under the supervision of a nephrologist. Common measures that do not depend on the nature of the origin of the nephrotic syndrome are the appointment of a s alt-free diet with a limited amount of liquid, symptomatic drug therapy (potassium preparations, diuretics, antihistamines, cardiac drugs, vitamins, heparin, antibiotics), bed rest, infusion of albumin, rheopolyglucin.
What else does the treatment of nephrotic syndrome involve?
When the genesis of the disease is not clear, in a condition caused by autoimmune or toxic kidney damage, steroid treatment with methylprednisolone or prednisolone (orally or intravenously through pulse therapy) is indicated for patients. Immunosuppressive steroid treatment helps to suppress the formation of antibodies, CEC, normalizes glomerular filtration and renal blood flow. A good effect of therapy for the hormone-resistant variant of the disease can be achieved by cytostatic therapy with chlorambucil and cyclophosphamide, which is carried out in pulse courses. During the period of remissiontreatment at climatic resorts is recommended. All recommendations for nephrotic syndrome must be strictly followed.
Diet
With the development of this pathology, the patient should follow a special diet. It is prescribed to patients who have pronounced swelling, with the ability of the kidneys to filter. Dietary nutrition also largely depends on the level of protein in the urine.
When diagnosed with nephrotic syndrome, the diet implies compliance with the following recommendations:
- eat 5 to 6 times a day in small portions;
- no more than 3,000 calories;
- it is forbidden to eat spicy and fatty foods;
- do not consume more than 4 g of s alt per day;
- drink at least 1 liter of fluid per day.
It is also recommended to eat a large amount of fruits and vegetables, as well as pasta, cereals, compotes, low-fat varieties of fish and meat, bran bread.
Prevention and prognosis
The course and prognosis are related to the nature and causes of the development of the underlying pathology. In general, the suppression of etiological factors, correct and timely treatment can restore kidney functionality and achieve stable remission. With unresolved causes, nephrotic syndrome often takes a relapsing or persistent course with a transition to chronic kidney failure.
Prevention of this disease includes early andenhanced treatment of extrarenal or renal pathology, which may be complicated by the occurrence of nephrotic syndrome, controlled and careful use of drugs that have allergic and nephrotoxic effects. In any case, if symptoms of this pathology occur, a timely visit to the doctor is recommended.
We have considered that this is nephrotic syndrome.
