Criteria for the diagnosis of nephrotic syndrome

Written by Wu Ji
Nephrology
Updated on September 27, 2024
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The diagnostic criteria for nephrotic syndrome include massive proteinuria, with urinary protein greater than 3.5 grams/day, hypoalbuminemia, with plasma albumin less than 30 grams/liter, severe edema, and hyperlipidemia, which includes significant increases in plasma cholesterol and triglycerides. The first two criteria are essential for the diagnosis of nephrotic syndrome, while the latter two are secondary. Clinically, if the two necessary criteria are met, the diagnosis of nephrotic syndrome is established. Patients with nephrotic syndrome should undergo a renal biopsy to determine the pathological type and guide clinical treatment.

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Manifestations of recovery from nephrotic syndrome

In principle, there is no concept of complete recovery for nephrotic syndrome. The condition of nephrotic syndrome can be alleviated and controlled to the greatest extent, but it cannot be completely cured. When the condition is alleviated, the patient's glomerular filtration barrier is repaired, resulting in a reduction in proteinuria and a decrease in urinary foam clinically. Once the patient's urinary protein decreases, the plasma protein concentration will gradually increase. Thus, water moves back from outside to inside the blood vessels, leading to a reduction in edema. These clinical signs all indicate an improvement in the condition of nephrotic syndrome. Of course, to assess the condition, it is still necessary to rely on the patient undergoing a 24-hour quantitative urine protein test.

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Conditions for discontinuing medication for nephrotic syndrome

The main clinical manifestations of nephrotic syndrome are significant proteinuria and hypoproteinemia, along with varying degrees of hyperlipidemia and edema. Nephrotic syndrome often requires treatment with corticosteroids. The general principle for using steroids is to start with a sufficient dosage and administer it slowly, maintaining it for a long duration, approximately around one year. Therefore, the conditions for discontinuing medication in nephrotic syndrome include: if the patient has been treated with steroids for about a year, and the proteinuria has resolved, 24-hour urinary protein quantification is normal, there is no edema, blood albumin levels have returned to normal, and kidney function is also normal, then discontinuation of steroid treatment can be considered. Of course, after stopping the medication, it is essential to regularly visit the hospital for monitoring of routine urine tests, kidney function, and blood pressure to prevent the recurrence of nephrotic syndrome due to infections or fatigue.

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Written by Zhang Hui
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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 Li Liu Sheng
Nephrology
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How to reduce swelling in the feet caused by nephrotic syndrome?

Swelling of the feet is a common phenomenon in nephrotic syndrome. Once swelling occurs, patients feel uncomfortable symptoms and a sensation of heaviness in their feet, so corresponding de-swelling treatment is necessary. How to reduce swelling? Firstly, a low-salt diet is essential to control salt intake, with daily salt consumption around 2 to 3 grams. In addition to this, small doses of diuretics such as hydrochlorothiazide and spironolactone can be used. If the diuretic effect is not satisfactory, other more potent diuretics like furosemide may be added. Of course, the fundamental treatment for foot swelling in nephrotic syndrome involves the use of steroids and immunosuppressants. This treatment works by suppressing the permeability of the glomerular basement membrane and reducing protein leakage, thereby ultimately eliminating the foot swelling.

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Is nephrotic syndrome prone to recurrence?

Nephrotic syndrome is characterized by more than 3.5 grams of proteinuria in 24 hours and a serum albumin concentration lower than 30 grams per liter. Treatment of this disease should be aimed at the cause, with most patients suffering from primary nephrotic syndrome related to immune dysfunction, therefore often requiring treatment with steroids. Indeed, some patients easily experience relapses; after a period of steroid treatment, proteinuria may decrease or even turn negative. However, upon cessation of the medication or during occurrences like a cold, some patients may suffer from relapses. Not all patients respond this way, as some are dependent on steroids.