Nephrotic syndrome

As suggested by the name, nephrotic syndrome is a syndrome. A syndrome is a condition in a patient who suffers from multiple vivid disorders which occur simultaneously. Usually, the reason for these disorders occurring simultaneously is that they are associated with each other by an underlying dysfunction. In nephrotic syndrome, there are four main disorders that are manifested due to some dysfunction at the level of nephrons in the kidneys. In this blog, we aim to understand these four disorders, their cause, symptoms, diagnosis, and treatment.

What is nephrotic syndrome?

The nephrotic syndrome appears as a tetrad of disorders. This tetrad is consisted of:

• Proteinuria greater than 3.5 grams in 24 hours
• Hypercholesterolemia
• Hypoalbuminemia
• Peripheral edema

To know the cause of this tetrad we must look at its pathophysiology. As already said, this tetrad is a result of some dysfunction at the level of nephrons; we will first look at the basic anatomy of nephrons to understand the pathophysiology of nephrotic syndrome effectively.

Anatomy of a nephron

A nephron is the functional unit of the kidney. An afferent arteriole comes into the head of the nephron to give an input of blood. This afferent arteriole makes the glomerulus within the head of the nephrons by twisting itself. The output of blood after being filtered in nephrons is the efferent arteriole coming out of it. This efferent arteriole joins the other efferent arteriole to form the renal vein. The renal vein eventually enters the circulation.

Pathophysiology of nephrotic syndrome

In nephrotic syndrome, an inflammation in the glomerulus causes it to be damaged. This inflammation can be the result of the action of antibodies, complement proteins, immune complexes, hypertension, or sclerosis. Whatever the cause, the inflammation and damage in the glomerulus are specifically caused in podocytes. Podocytes are the cells that prevent protein loss. This damage in podocytes acts as an initiative for the tetrad to occur resulting in nephrotic syndrome. To understand this, we will discuss the progressive cause of each of the disorders of nephrotic syndrome:

• Proteinuria: podocyte damage allows the protein to pass into the tubules of the nephron. This protein travels through the nephron tubules and becomes part of the urine. This loss of protein through urine results in mass Proteinuria, Hematuria, and loss of antibodies.
•  Hypoalbuminemia: the mass loss of protein via urine such as albumin from the circulation results in Hypoalbuminemia in the blood.
• Hypercholesterolemia: Due to Hypoalbuminemia, liver production is stimulated. The liver then works on overdrive for every product it produces resulting in the production of not only albumin but also cholesterol. This overproduction of cholesterol is not needed in the body thus leading to hypercholesterolemia.
• Peripheral edema: Hypoalbuminemia also results in reduced plasma oncotic pressure. The reduced oncotic pressure is the representation of the water and electrolytes moving into the interstitium. This happens because when there are no proteins in the vascular compartment to hold water and electrolytes. This leads to peripheral edema as the swelling of the tissues occur. Generally swelling due to edema is first seen in feet.

Symptoms of nephrotic syndrome

• Xanthelasma: deposition of cholesterol in the eye
• Xanthomata: deposition of cholesterol in the skin
• Tiredness
• Leukonychia: the appearance of white lines or dots on the fingernail
• Periorbital edema: fluid in the eye
• Ascites: fluid in the abdomen
• Peripheral edema
• Breathlessness
• Frothy urine

Diagnosis of nephrotic syndrome

Diagnosis of nephrotic syndrome is done to; confirm the presence of the condition, assess the severity and differentiate different types of nephrotic syndrome based on its causes. This diagnosis can be done by:

• Urine dipsticks
• Full blood count
• Liver function test
• Calcium level evaluation by a blood test
• C- reactive protein test
• Screening of urine globulin
• Chest X-ray
• Ultrasound of kidney
• Renal biopsy

Treatment of the nephrotic syndrome

As nephrotic syndrome can have numerous causes, it is important to consider the relevancy of a treatment option for a specific patient. But regardless of the cause, there are certain general protocols to be made operational for a patient suffering from nephrotic syndrome. These protocols are as follows:

• Using medications such as ACE inhibitors and Angiotensin receptor blockers: this is done to reduce intraglomerular capillary pressure
• Giving patients loop diuretics: This is done to reduce edema but it is important for patients to be on a low-sodium diet in order to work this procedure for them
• Strict blood pressure control
• HMG-CoA reductase inhibitors: To treat hyperlipidemia   

Conclusion

In this blog, we have viewed certain important measures associated with nephrotic syndrome. No matter how specific we try to be in medical content like this, it is important to promote the idea of personal advice given to a patient by his/her doctor. The importance of a checkup from an expert can never be overstated.

To book an appointment for this expert checkup for any kidney-related issue contact Alfa Kidney care