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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Written by Niu Yan Lin
Nephrology
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Does nephrotic syndrome require a puncture?

Nephrotic syndrome is a complex of clinical symptoms with various causes, which differ by age group. In children or adolescents, if it presents solely as significant proteinuria without elevated creatinine or hematuria, it is generally caused by minimal change disease. Since this type of kidney disease is sensitive to hormone treatment, it is usually possible to forego renal biopsy and start with corticosteroid therapy. For other nephrotic syndrome patients, it is advisable to first perform a renal biopsy to identify the pathological cause before considering appropriate treatment with hormones, immunosuppressants, and other medications.

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Written by Zhou Qi
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Does nephrotic syndrome easily lead to cerebral infarction?

Nephrotic syndrome is a high-risk factor for cerebral infarction, making patients prone to strokes. This is because patients with nephrotic syndrome excrete large amounts of protein in their urine, which reduces protein concentration in the plasma and disrupts the anticoagulant fibrinolysis system, leading to an increased tendency to form blood clots. These clots are prone to develop in the veins of the lower extremities and the renal veins, and cerebral arteries in the skull are also susceptible to occlusion. Therefore, in such patients, if the plasma albumin level is very low, such as below 20 grams per liter, there is a need for routine use of anticoagulant medications.

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Written by Zhang Hui
Nephrology
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How should you eat with nephrotic syndrome?

Nephrotic syndrome is characterized by urine protein greater than 3.5 grams, serum albumin less than 30, the presence of edema, and hyperlipidemia. Patients matching these criteria can be diagnosed with nephrotic syndrome. From its diagnosis, we can see that such patients have a high amount of urine protein and relatively low blood protein. For these patients, it is necessary to control their protein intake, generally suitable at 0.6-0.8 grams per kilogram of body weight per day. Due to hypoalbuminemia, as the liver synthesizes protein, it also leads to an increase in blood lipids. Therefore, patients with nephrotic syndrome need to follow a low-fat diet to avoid further elevation of blood lipids. Additionally, as patients with nephrotic syndrome generally have edema, it is necessary to restrict sodium intake to prevent sodium and water retention, further aggravating the edema.

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Written by Zhou Qi
Nephrology
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How long will it take for nephrotic syndrome to get better?

Most cases of nephrotic syndrome are primary nephrotic syndrome, which refers to the absence of specific causes and may be related to immune dysfunction. The disordered immune system attacks the glomerular capillaries causing damage to the filtration barrier, resulting in the patient excreting large amounts of urinary protein. For primary nephrotic syndrome, treatment generally involves the use of corticosteroids or a combination of hormones and immunosuppressants. About 50-60% of patients respond effectively to the medication, which typically takes about two months to take effect. Patients who respond quickly might see effects within one to two weeks, while those with less sensitivity to the medication may need three to four months. The general course of medication is about one year.

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Written by Zhou Qi
Nephrology
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What to do if nephrotic syndrome causes leg pain?

Patients with nephrotic syndrome who experience leg pain mostly have conditions unrelated to nephrotic syndrome itself. It could be due to diseases of the skeletal or muscular system. However, some patients might experience leg pain due to thrombosis caused by nephrotic syndrome, leading to ischemia in the limbs. Also, long-term use of corticosteroids can lead to necrosis of the femoral head, osteoporosis, and pain. Therefore, treatment should be targeted based on the cause, such as using drugs to dissolve clots or interventional surgery for those with thrombosis. In severe cases of femoral head necrosis, a femoral head replacement surgery might be necessary, and it is important to supplement with calcium regularly.