Causes of edema in nephrotic syndrome

Written by Zhou Qi
Nephrology
Updated on September 04, 2024
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Edema is a diagnostic criterion for nephrotic syndrome, as well as a major clinical symptom and characteristic of the syndrome. There are several reasons why patients develop edema.

First, a large amount of protein leaks out from the kidneys, causing a decrease in the concentration of plasma albumin and a decrease in the colloid osmotic pressure in the plasma, which makes it easy for water to move from inside the blood vessels to outside, causing edema.

Second, patients with nephrotic syndrome have increased vascular permeability, which also makes it easy for water to enter the interstitial tissues. Among patients with nephrotic syndrome, some are prone to acute renal failure, which further decreases the kidney's ability to excrete water, and these factors together lead to the common occurrence of edema in patients.

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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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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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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 Wu Ji
Nephrology
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Criteria for the diagnosis of nephrotic syndrome

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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Written by Zhu Wei
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What should not be eaten with nephrotic syndrome?

Patients with nephrotic syndrome, if the patient has obvious edema, should limit salt intake to between two to three grams per day. It is suggested to consume foods rich in polyunsaturated fatty acids, such as vegetable oils, as well as foods rich in soluble fiber, such as oats. They should also receive a normal amount of 0.8 to 1 gram of high-quality protein per kilogram of body weight per day, mainly from egg whites, milk, lean meat, and fish. Calorie intake should be sufficient, and patients with nephrotic syndrome should eat less salty and pickled foods and consume less animal fat.