Nephrotic Syndrome

Nephrotic Syndrome

Nephrotic syndrome is damage to the kidneys that causes high levels of protein in the urine . The high level of protein is caused by leakage in the part of the kidney that functions to filter blood ( glomerulus ) .

Nephrotic syndrome is a type of kidney disease in children and adults. This condition that attacks the urinary system  can be treated by taking drugs given by a doctor.

If nephrotic syndrome occurs as a result of another disease, such as diabetes or lupus, the doctor will also treat the condition that causes the nephrotic syndrome.

Causes of Nephrotic Syndrome

Nephrotic syndrome occurs due to damage to the glomerulus, which is the part of the kidney that functions to filter blood and produce urine. As a result, protein that should remain in the blood instead leaks into the urine. Under normal conditions, urine does not contain protein.

There are two types of nephrotic syndrome, namely primary nephrotic syndrome and secondary nephrotic syndrome. In primary nephrotic syndrome, the glomerulus undergoes changes in the form of thickening or the formation of scar tissue so that it cannot function normally. However, it is not known exactly why these changes occurred.

Meanwhile, secondary nephrotic syndrome occurs due to other diseases that cause damage to the kidneys. Some diseases that can cause secondary nephrotic syndrome are:

  • Diabetes
  • Lupus
  • Infectious diseases, such as leprosy, syphilis , HIV, malaria, or hepatitis B and hepatitis C
  • Henoch-Schonlein purpura
  • Rheumatoid arthritis
  • Amyloidosis
  • Cancer, such as leukemia or lymphoma
  • Sjogren's Syndrome
  • Erythema multiforme

In addition to the several diseases above, consumption of drugs that affect kidney function, such as non-steroidal anti-inflammatory drugs or interferon alpha, can also increase a person's risk of developing nephrotic syndrome. Heroin abuse is also at risk of causing nephrotic syndrome.

Symptoms of Nephrotic Syndrome

The main symptom of nephrotic syndrome is fluid buildup in the body or edema. Edema occurs due to low protein in the blood.

One of the functions of protein in the blood is to hold fluid in the blood. If the protein level is lacking, fluid from the blood vessels will leak out and accumulate in the body's tissues.

In children, edema caused by nephrotic syndrome can be observed from facial swelling. Whereas in adults, edema can be seen from swelling in the heels followed by swelling in the calves and thighs.

Other symptoms of nephrotic syndrome that can appear are:

  • Foamy urine due to protein in the urine
  • Diarrhea
  • Nauseous
  • Tired, lethargic, and loss of appetite
  • Weight gain due to accumulation of body fluids

Nephrotic syndrome caused by other diseases will also cause the above symptoms and specific symptoms of the disease that causes it. For example, nephrotic syndrome caused by rheumatoid arthritis will be accompanied by symptoms of joint pain.

When to go to the doctor _

If you have lupus or diabetes, follow the doctor's recommendations for treatment and continue to control them regularly even if they are not causing symptoms. Both diseases require long-term treatment.

Immediately see a doctor if you experience symptoms of nephrotic syndrome, such as edema followed by foamy urine, so that you get a doctor's examination and help. This needs to be done because untreated nephrotic syndrome can lead to permanent chronic kidney failure.

Diagnosis of Nephrotic Syndrome

During the initial examination, the doctor will ask about the patient's symptoms and medical history, followed by examining the patient's physical condition. In pediatric patients, the doctor will also ask their families if any family members have ever had the disease.

If from the initial examination the doctor suspects the patient has nephrotic syndrome, a further examination will be carried out, which includes:

Urine test

The urine sample will be checked in the laboratory to see if there is leaking protein. The doctor may ask the patient to take a urine sample for the full 24 hours.

Blood test

The doctor will take a patient's blood sample to check the level of protein in the blood (albumin), accompanied by kidney function tests. Blood tests can also be done to find out the cause of nephrotic syndrome, for example testing blood sugar levels for people with diabetes.

Kidney biopsy

This procedure is used to take a tissue sample in the kidney. A kidney biopsy is done to examine the kidney tissue under a microscope.

Nephrotic Syndrome Treatment

Treatment of nephrotic syndrome by a kidney doctor depends on the cause. There are several drugs that can be given to people with nephrotic syndrome, including:

1. Corticosteroid corticosteroid drugs

This drug functions to treat inflammation of the kidneys or treat inflammatory diseases that cause nephrotic syndrome, such as lupus or amyoloidosis. An example of this drug is methylprednisolone .

2. Antihypertensive drugs

This drug functions to lower blood pressure which can increase when kidney damage occurs. Medications for high blood pressure can also reduce the amount of protein that is wasted in the urine. An example of this drug is an ACE inhibitor drug , such as enalapril or catropril .

3. Diuretic drugs

The function of diuretic drugs is to remove excess fluid from the body so that it can reduce the symptoms of edema. An example of a diuretic drug is furosemide .

4. Blood thinning drugs

The function of this drug is to reduce the risk of blood clots which are complications of nephrotic syndrome. An example of this drug is heparin .

5. Drug penicillin

Penicillin is an antibiotic drug used to prevent infections which are complications of nephrotic syndrome.

If the protein in the blood is too low, the doctor can give albumin through an IV. Doctors will also advise patients to undergo kidney transplantation or dialysis if they have chronic kidney failure.

The patient 's diet also needs to be regulated. Patients need to consume enough protein, neither more nor less. In addition, patients need to reduce consumption of salt, fat, and cholesterol to prevent complications and reduce edema. Consult with a nutritionist regarding diet for people with nephrotic syndrome.

The cure rate for this condition really depends on the cause, severity, and the body's response to treatment. Generally, sufferers of childhood can recover, although 70% of them will experience it again in the future.

Nephrotic Syndrome Complications

Nephrotic syndrome that is not handled properly can cause complications, such as:

  • Hypertension due to disorders of the kidneys
  • Low albumin levels ( hypoalbuminemia ) and anasarca edema due to large amounts of albumin protein in the blood are wasted with urine
  • Increased levels of cholesterol and triglycerides in the blood
  • The formation of blood clots due to natural blood-thinning protein is also wasted with urine so that it risks causing blockages in the veins
  • Vulnerable to infection due to antibodies in the blood are also wasted with urine
  • Acute kidney failure or chronic kidney failure is caused by the kidneys not being able to filter blood optimally

Prevention of Nephrotic Syndrome

Nephrotic syndrome of unknown cause (primary nephrotic syndrome) is difficult to prevent. However, nephrotic syndrome that arises due to other diseases can be prevented by treating the disease that causes it.

For example, diabetics need to take blood sugar control medication from a doctor, as well as follow a diet and exercise regimen recommended by a doctor.

The next step that is no less important is to prevent complications of nephrotic syndrome, one of which is kidney failure due to permanent damage to the kidneys. This can be done by undergoing treatment as recommended by a kidney doctor, as well as being disciplined in implementing the diet recommended by a nutritionist.

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