Nephrotic syndrome isn't a disease but is characterized by marked proteinuria, hypoalbuminemia, hyperlipidemia, increased coagulation, and edema. It results from a glomerular defect that affects the vessels permeability and indicates renal damage. The prognosis is highly variable, depending on the underlying cause, but age plays no part in progression or prognosis. Some forms of nephrotic syndrome may eventually progress to end-stage renal failure.
Nephrotic syndrome can be due to a vast array of diseases that affect other parts of the body, most commonly diabetes mellitus, systemic lupus erythematosus, and certain viral infections. Nephrotic syndrome can also result from nephritic syndrome. A number of drugs that are toxic to the kidneys can also cause nephrotic syndrome, especially nonsteroidal anti-inflammatory drugs (NSAIDs). The syndrome may be caused by certain allergies, including allergies to insects and poison ivy. Some types of the syndrome are hereditary.
Signs and Symptoms
Swelling around the following body parts:
Urinalysis reveals an increased number of hyaline, granular, and waxy, fatty casts as well as oval fat bodies. Consistent, heavy proteinuria (levels over 3.5 mg/dl for 24 hours) strongly suggests nephrotic syndrome.
Serum values that support the diagnosis include increased levels of cholesterol, phospholipids (especially low-density and very-low-density lipoproteins), and triglycerides, and decreased albumin levels.
Histologic identification of the lesion necessitates a renal biopsy.
Effective treatment of nephrotic syndrome requires correction of the underlying cause if possible. Supportive treatment consists of a nutritious diet of 0.6 g of protein per kilogram of body weight, with restricted sodium intake, diuretics for edema, and antibiotics for infection.
Some patients respond to an 8-week course of a corticosteroid such as prednisone followed by maintenance therapy. Others respond better to a combination of prednisone and azathioprine or cyclophosphamide. Treatment for hyperlipidemia frequently is unsuccessful.
Many times the disorder cannot be prevented, although treatment of illness and infection may help to reduce the risk.
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