Have A Common Understanding About Nephrotic Syndrome

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1. The definition of nephrotic syndrome

Nephrotic syndrome (NS), referred to as a renal syndrome, can be caused by a variety of etiologies. A group of clinical syndromes manifested as massive proteinuria, hypoalbuminemia, high edema, and hyperlipidemia. Nephrotic syndrome can be associated with many complications, such as infection, hypercoagulability, and thromboembolism. Among them, infection, especially pulmonary infection, is a common complication of nephrotic syndrome, and it is also the main cause of nephrotic syndrome progression, recurrence, and death.

2. The etiology of nephrotic syndrome

Nephrotic syndrome can be divided into primary and secondary, with different causes. Secondary refers to a nephrotic syndrome caused by other diseases. Diabetes, multiple myeloma, systemic lupus erythematosus, hepatitis B, and many other diseases can cause nephrotic syndrome. When the body has no other disease, but the nephrotic syndrome is caused by the disease of the kidney itself, it is called primary nephrotic syndrome.

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3. The clinical manifestations of nephrotic syndrome

In general, the main clinical manifestations of the nephrotic syndrome have the following forms:

Macroalbuminuria and hypoalbuminemia

Clinically, through the routine urine test of patients, if a large amount of proteinuria is found in the quantitative detection of urine protein, and there is a lot of foam in the urine, the main reason for the occurrence of a large amount of proteinuria is that the pressure of the glomerulus is too large. , resulting in a decrease in the filtering function of the kidneys, and the protein in the urine is not completely filtered, which leads to the formation of a large amount of proteinuria.

Edema

Because the osmotic pressure of plasma colloid in patients with kidney disease decreases, which affects the absorption of water, the water leaks out of the interstitial space and causes edema. The first occurrence of edema is the loose subcutaneous tissue, such as the eyelids, face, etc., and then appears in the lower extremities. The lower extremities usually start from the ankles, and there will be acupressure and pitting edema. In severe cases, systemic edema may occur, causing Pleural effusion, ascites, and pericardial effusion. Secondly, the edema of the patient may have a significant relationship with the body position. If there is only fixed edema of one lower extremity that is not related to the body position, it is necessary to consider whether it is the formation of venous thrombosis of the lower extremity.

Hyperlipidemia

Due to the decline of intestinal function, the intake of protein will be reduced, and the decomposition of ingested protein by the body will also decrease, and the lipoprotein synthesized by the liver will increase, which will lead to the increase of high lipoprotein in the patient. cause hyperlipidemia.

related complications

Due to repeated abnormal immune function in patients with nephrotic syndrome and long-term use of hormones, it is very likely to cause infection in the body; the viscosity of the blood in the patient's body will increase, and the amount of protein lost in the body will be too much. The hypercoagulable state can lead to thrombosis and embolic complications; if the patient is in a state of illness for a long time and does not receive timely examination and treatment, it will lead to acute renal failure in severe cases.

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4. The diagnostic criteria for the nephrotic syndrome(Both items of 1.2 must be satisfied [4])

1. Urine protein is greater than 3.5g/d;

2. Plasma albumin is less than 30g/d;

3. Edema;

4. Increased blood lipids;

The occurrence of massive proteinuria is due to the damage of the molecular barrier or charge barrier of the glomerular filtration membrane, which leads to an increase in the protein content in the original urine, which significantly exceeds the reabsorption of the proximal convoluted tubule. Nephrotic syndrome is the loss of a large amount of albumin from the urine, which promotes the compensatory increase in the synthesis of albumin in the liver. When the increase in the synthesis of albumin in the liver is insufficient to overcome the lost and decomposed albumin, hypoalbuminemia occurs in the blood. In nephrotic syndrome, low plasma albumin leads to a decrease in plasma osmotic pressure, so that water flows from the blood vessels to the interstitial space, which is the main reason for the formation of edema. Hyperlipidemia is mainly manifested as hypercholesterolemia, coexisting with hypoproteinemia, which is mainly related to the weakening of lipoprotein decomposition by the liver and the increase of lipoprotein synthesis.

5. Nephrotic syndrome dietary taboos

1. Low-fat intake in the diet:

Patients with nephrotic syndrome are usually accompanied by hyperlipidemia, which will increase the viscosity of blood and cause arteriosclerosis and glomerular damage, and hardening. Therefore, patients should choose low-fat foods in their diet, and try to keep their diet as light as possible. host.

2. High protein intake in the diet:

Patients with nephrotic syndrome will have hypoproteinemia, and a large amount of plasma protein is excreted in the urine, resulting in a decrease in the body's protein content. Therefore, it is necessary to give enough high-quality protein and calories in the diet, such as meat, milk, egg protein, etc., to effectively improve the patient's hypoproteinemia.

3. The intake of trace elements in the diet:

Due to the increased permeability of the glomerular basement membrane in patients with nephrotic syndrome, in addition to losing a large amount of protein during urination, they also lose trace elements and hormones combined with proteins, resulting in calcium, magnesium, zinc, and iron in the human body. Therefore, patients can supplement the diet by ingesting vegetables, fruits, and whole grains that contain these trace elements.

4. Control the intake of salt in the diet:

Patients with nephrotic syndrome mainly have water and sodium retention, and sodium will also remain in the patient's body. Too high a sodium content can cause high blood pressure and aggravate the patient's edema. Therefore, for patients with nephrotic syndrome, try not to eat too salty, you can eat some low-sodium foods, but be careful, you need to control the intake of salt under the guidance of a doctor because eating too much low-sodium salt will cause blood potassium in the patient. This can lead to cardiac arrest, which seriously threatens his life.

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