What is nephrotic syndrome?

Written by Wu Ji
Nephrology
Updated on September 27, 2024
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Nephrotic syndrome is a common manifestation of glomerular disease, caused by a variety of etiologies, with large differences in treatment response and prognosis. The pathological causes of nephrotic syndrome are diverse, with the most common types being minimal change disease, focal segmental glomerulosclerosis, mesangial proliferative nephritis, membranous nephropathy, and membranoproliferative glomerulonephritis. Nephrotic syndrome can be classified into primary and secondary types based on its cause. The diagnosis of primary nephrotic syndrome mainly depends on the exclusion of secondary nephrotic syndrome. Common causes of secondary nephrotic syndrome include diabetic nephropathy, lupus nephritis, renal amyloidosis, drug-induced nephropathy, and renal tumors.

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Characteristics of Nephrotic Syndrome

The characteristic feature of nephrotic syndrome is that patients may experience edema, which is related to the nature of this disease. The essence of this disease is due to some reason that damages the glomerular capillary filtration barrier. As a result, when blood passes through the glomeruli, it leaks proteins from the blood. A 24-hour urinary protein quantification will exceed 3.5 grams, which constitutes a large amount of urinary protein. Consequently, a large amount of protein is leaked into the urine, causing the protein concentration in the plasma to decrease. This leads to a reduction in the colloidal osmotic pressure of the plasma, causing fluid to move from inside the blood vessels to outside, thus leading to edema. Therefore, the most significant clinical feature of nephrotic syndrome is the potential to cause edema, and severe cases of edema may elevate blood pressure, lead to pulmonary edema, manifesting as difficulty breathing, chest tightness, and shortness of breath.

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What tests are conducted for nephrotic syndrome?

Patients with nephrotic syndrome need to complete routine urine tests, 24-hour urine protein quantification, liver and kidney function tests, routine blood tests, electrolyte panels, blood glucose tests, and lipid profiles. Additionally, it is important to determine the cause of nephrotic syndrome, excluding the possibility of nephrotic syndrome caused by immune system diseases, including tumors, vasculitis, lupus, and other diseases. These tests include rheumatoid immune panels, antinuclear antibody spectrum, anti-GBM antibodies, ANCA panel, and immunoglobulins. Moreover, these patients should undergo kidney ultrasound, tumor marker tests, and thyroid function tests.

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Is nephrotic syndrome hereditary?

Nephrotic syndrome is generally not hereditary. It refers to a group of clinical symptoms and manifestations. The fundamental issue in patients is the damage to the glomerular capillaries, which leads to significant proteinuria, subsequently causing edema, hyperlipidemia, and hypoalbuminemia in the plasma. The causes of this disease are classified into primary and secondary types. Primary nephrotic syndrome is related to immune system dysfunction and may involve multiple genes; therefore, the disease is not considered a clear hereditary disease, but the likelihood of offspring developing renal issues may be higher than in the general population. Secondary nephrotic syndrome is mostly related to factors such as hepatitis B infection, allergies, diabetes, etc., and these diseases are not hereditary either.

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Do you take steroids for nephrotic syndrome?

Once nephrotic syndrome is diagnosed, corticosteroid therapy becomes a primary treatment, and the commonly used steroid is prednisone. If there is liver damage or the treatment effect of prednisone is not good, oral prednisolone or intravenous methylprednisolone can be used. Due to its long half-life and severe side effects, dexamethasone is now generally less used. The course of treatment with corticosteroids for nephrotic syndrome is relatively long, needing about one to one and a half years. During this process, the use of steroids has three phases: the initial full-dose phase, during which a relatively large dose of the hormone is used for about two to three months; the second phase is a slow reduction process; the third phase is a low-dose maintenance process. Overall, during the use of steroids, patients must regularly follow up at outpatient clinics, and adjust the steroids according to the doctor's advice. One must not arbitrarily reduce the dose or stop the medication, as this can easily lead to a relapse of nephrotic syndrome.

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Can people with nephrotic syndrome eat strawberries?

Patients with nephrotic syndrome can eat strawberries in moderate amounts. Patients with nephrotic syndrome typically have urinary protein levels exceeding 3.5g in 24 hours, along with noticeable symptoms of edema. It is essential for these patients to control their intake of water, especially those with severe edema, as excessive water intake can further exacerbate the swelling. Additionally, patients should limit their intake of plant proteins, follow a low-salt diet, and avoid heavy consumption of oils and fatty foods. From the above perspectives, it is generally acceptable for patients with nephrotic syndrome to eat strawberries in moderation. Strawberries contain very little plant protein and will not increase urinary protein levels. Although strawberries do not contain much salt, patients with nephrotic syndrome still need to consume them in moderation due to their high water content.