Acute and chronic nephrotic syndrome

If a patient has kidney damage and edema, and the diagnosis determines the presence of proteinuria, electrolyte, protein and fat metabolism disorders, the doctor can diagnose "nephrotic syndrome" has been using this term in medicine for about 70 years. Previously, the disease was called nephrosis, or lipoid nephrosis.

Nephrotic syndrome often develops due to inflammatory processes in the kidneys, as well as against other complex pathologies, including autoimmune ones.

Definition of a nephrotic syndrome: what is it?

The disease we are considering is a complex of symptoms, a pathological condition in which a significant daily excretion of protein with urinary fluid occurs (more than 3.5 g / 1.73 m²). Pathology is also characterized by hypoalbuminuria, lipiduria, hyperlipidemia, edema.

In healthy people, the daily physiological excretion of protein through the kidneys is less than 150 mg (more often - about 50 mg). Such proteins are represented by plasma albumins, enzyme and hormonal substances, immunoglobulins, kidney glycoprotein.

In nephrotic pathology, such abnormalities as hypoalbuminuria, dysproteinemia, hyperlipidemia, lipiduria, as well as marked swelling on the face, in the cavities and throughout the body are found.

Nephrotic syndrome is divided into primary and secondary type, depending on the etiology of the disease. The primary type is said if it develops against the background of other kidney diseases. The secondary type is diagnosed somewhat less often: its development is associated with the "intervention" of other diseases (collagenoses, rheumatism, hemorrhagic vasculitis, chronic purulent inflammatory processes, infections, tumors, allergies, etc.).

[1], [2], [3], [4], [5], [6], [7]

Epidemiology

Annually, 2-7 primary cases of nephrotic syndrome per 100 thousand population are recorded. The disease can occur at any age, for any violations of kidney function.

The degree of spread in children is about 14-15 cases per 100 thousand.

[8], [9], [10], [11], [12]

Causes of the nephrotic syndrome

The causes of nephrotic syndrome are manifold, but most often the disease develops as a consequence of glomerulonephritis - either acute or chronic. Statistics indicate that with glomerulonephritis complication occurs in about 75% of cases.

Other frequent factors are:

• primary amyloidosis;
• hypernfrom;
• nephropathy in pregnancy.

Secondary nephrotic syndrome develops in the background:

• diabetes mellitus;
• infectious pathologies (such as malaria, syphilis, tuberculosis);
• autoimmune diseases (systemic lupus erythematosus, systemic scleroderma, rheumatoid arthritis);
• allergic processes;
• periarteritis;
• septic endocarditis;
• hemorrhagic vasculitis;
• lymphogranulematosis;
• severe intoxication;
• malignant processes;
• thrombotic complications affecting renal veins, inferior vena cava;
• frequent and lengthy courses of treatment with various medications, including chemotherapy.

This type of development of nephrotic disease, the cause of which can not be determined, is called idiopathic. It occurs mainly in children.

[13], [14]

Risk factors

The development of nephrotic syndrome can be provoked by such risk factors:

• prolonged or regular treatment with non-steroidal anti-inflammatory drugs (acetylsalicylic acid, voltaren);
• frequent and prolonged therapy with antibiotics;
• infectious diseases (tuberculosis, syphilis, malaria, hepatitis B and C, human immunodeficiency virus);
• allergic processes;
• autoimmune processes;
• endocrine diseases (thyroid disease, diabetes, etc.).

[15], [16], [17], [18], [19], [20], [21], [22], [23], [24]

Pathogenesis

To date, a number of theories are known according to which, presumably, the development of the nephrotic symptom complex occurs. The most plausible is the immunological concept of the onset of the disease. Its proof is the frequent development of pathology in people in the body of which there are allergic and autoimmune processes. This theory is also confirmed by a large percentage of successful treatment with immunosuppressive agents. During the development of the nephrotic syndrome in the blood, immunocomplexes are formed, which are a consequence of the relationship between internal and external antigens and antibodies.

Formed immunocomplexes are able to settle inside the kidneys, which causes a reciprocal inflammatory process. There are violations of microcirculation in the capillary network of glomeruli, coagulation inside the vessels is increasing.

Filtration of glomeruli is disturbed by changes in permeability. As a result - violations in the processes of protein metabolism: the protein enters the urinary fluid and leaves the body. Increased excretion of protein causes hypoproteinemia, hyperlipidemia, etc.

In nephrotic syndrome, the appearance of the organ also changes: the kidney increases in volume, the intercalary layer changes color and becomes reddish, and the cortical layer becomes grayish.

Pathophysiology

Excretion of protein with urinary fluid occurs as a result of disorders affecting the endothelial cells of the capillary network, the glomerular basal membrane - that is, the structures normally filtering the plasma protein selectively, strictly according to a certain volume and mass.

The process of damage to these structures is poorly understood in the primary lesion of the glomeruli. Presumably, T-lymphocytes begin to redundantly release the circulating permeability factor, or inhibit the production of an inhibitory permeability factor, responding to the appearance of undetectable immunogens and cytokines. Among other probable factors, hereditary anomalies of proteins that make up the slit glomerular diaphragm can not be ruled out.

[25], [26], [27], [28], [29], [30], [31], [32], [33]

Symptoms of the nephrotic syndrome

Clinical manifestations largely depend on the initial cause of the appearance of pathology.

The first major signs are swelling, increasing anemia, general deterioration of well-being, violation of diuresis towards oliguria.

The general picture of a nephrotic syndrome is represented by such symptoms:

• clouding of urine, a sharp decrease in its daily amount;
• varying degrees of puffiness, from moderate to very severe;
• a breakdown in strength, a growing sense of fatigue;
• loss of appetite, thirst, dry skin and mucous membranes;
• rarely (for example, in the presence of ascites) - nausea, diarrhea, discomfort in the abdomen;
• frequent pain in the head, in the lower back;
• muscle cramps and pain (with prolonged course of nephrotic syndrome);
• dyspnea (due to ascites and / or hydropericarditis);
• apathy, lack of mobility;
• pallor of the skin, deterioration of the skin, nails, hair;
• increased heart rate;
• the appearance of a dense plaque on the surface of the tongue, an increase in the abdomen;
• signs of increased blood coagulation.

Nephrotic syndrome can develop at different rates - both gradually and rapidly. In addition, distinguish between the pure and mixed course of the disease. The difference lies in the additional presence of high blood pressure and hematuria.

• Edema in nephrotic syndrome can be expressed in different ways, but they are always present. Initially, the liquid accumulates in the tissues of the face - under the eyes, on the cheeks, in the forehead and lower jaw. Such a sign is called "the face of a nephrotus." Over time, the accumulation of fluid spreads to other tissues - there is edematous extremities, lumbar spine, ascites, hydropericardium, hydrothorax develops. In severe cases anasarca develops - puffiness of the body as a whole.

The mechanism of edema in nephrotic syndrome is different. For example, often the puffiness is provoked by the increased content in the bloodstream of sodium chloride. With excess volume of fluid in the body, moisture begins to penetrate through the vascular wall in a number of located tissues. In addition, nephrotic syndrome is accompanied by increased loss of albumin with urinary fluid, which leads to an imbalance in the oncotic pressure. As a consequence, moisture with additional force leaves the tissue.

• Oliguria with nephrotic syndrome is dangerous because it can provoke the development of such complications as renal failure. In patients, the daily volume of urine can be 700-800 ml and even less. At the same time, the content of protein, lipids, pathogenic microorganisms is significantly exceeded, and sometimes blood is present (for example, with glomerulonephritis and systemic lupus erythematosus).
• Ascites with nephrotic syndrome are observed against a background of severe pathology. The fluid accumulates not only in the tissues, but also in the body cavities - in particular, in the abdominal cavity. Simultaneous formation of ascites with accumulation of moisture in the pericardial and pleural cavities indicates the rapid appearance of diffuse (widespread) edema of the body. In a similar situation, they talk about the development of a general dropsy, or anasarka.
• Arterial hypertension in nephrotic syndrome is not a basic or mandatory symptom. Pressure indicators may increase in the case of a mixed course of nephrotic syndrome - for example, with glomerulonephritis or systemic diseases.

Nephrotic syndrome in adults

Adults suffer from nephrotic syndrome mainly at the age of 30-40 years. Pathology is more often noted as a result of a glomerulonephritis, pyelonephritis, primary amyloidosis, hypernephrosis or nephropathy during pregnancy.

Secondary nephrotic syndrome is not directly related to kidney damage and happens under the influence of collagenoses, rheumatic pathologies, purulent processes in the body, infectious and parasitic diseases

Nephrotic syndrome in women and men develops with approximately the same frequency. The disease in most cases manifests itself in one "scenario", while the leading symptom is proteinuria more than 3.0 g / day, sometimes reaching 10-15 g and even more. Up to 85% of the protein excreted with urine is albumin.

Hypercholesterolemia is also capable of reaching a limit of 26 mmol / liter and more. However, medicine also describes cases when the cholesterol content was in the upper normal range.

As for puffiness, this sign is considered very specific, as it is found in most patients.

Nephrotic syndrome in children

Nephrotic syndrome in an overwhelming number of children is idiopathic. The pathogenesis of such a painful condition, passing with minimal disturbances, has not yet been fully studied. Presumably, there is an increase in glomerular permeability for plasma protein due to the influence of circulating factors on the capillary network of the glomerulus, with further damage to the diaphragms between the processes of the podocytes. Probably, active T-killers secrete lymphokines that affect glomerular permeability with respect to plasma proteins, which leads to proteinuria.

The first clinical signs in children are swelling, which can occur little by little or intensely, capturing more and more tissues.

The prognosis of  nephrotic syndrome in childhood  depends on the response to treatment with glucocorticosteroids and immunosuppressors. With steroid-sensitive nephrotic syndrome, remission is achieved in 95% of cases, without impairing renal function.

The steroid-resistant variant is able to progress to the terminal stage of CRF (within 5-10 years).

Stages

• Acute nephrotic syndrome is characterized by swelling, which occurs in the morning in the face area, and closer to the evening "falls" to the lower limbs. There is also clouding and a decrease in the amount of urinary fluid. Patients complain of weakness, apathy, headaches. If the symptoms do not appear dramatically, but increase gradually, they talk about the subacute course of the disease.
• Chronic nephrotic syndrome is diagnosed when the main signs of the pathology either appear or disappear (usually with a different time interval - that is, the aggravation can happen once every few months or in six months). The clinical picture of the period of exacerbation resembles the symptomatology of acute nephrotic syndrome. With regular repetitions they speak of the transition of the disease to a chronic recurrent form.

[34], [35], [36], [37], [38], [39], [40]

Forms

Standard nephrotic syndrome is divided into primary and secondary type (we already wrote about it above). However, attention should be paid to other existing varieties of pathology in order to broaden the general understanding of the disease.

• Congenital nephrotic syndrome is a pathology that develops in a baby before reaching the age of 3 months. The congenital disease is primary (genetically caused syndrome) or secondary (against the background of such congenital pathologies as cytomegalia, toxoplasmosis, syphilis, tuberculosis, HIV, thrombosis of renal veins). Primary syndrome refers to the autosomal recessive inherited pathology, which manifests itself literally from the first day of the baby's life. With severe proteinuria and the development of renal insufficiency, there is a high risk of mortality - for several months.
• Idiopathic nephrotic syndrome is a pathology that is diagnosed in 90% of cases in children. There are several histological forms of idiopathic pathology: it is a disease of minimal changes, mesangium proliferation and focal segmental glomerulosclerosis. The disease of minimal changes in 95% of cases is completely recovered by patients. With the proliferation of mesangium in 5% of cases, diffuse growth of mesangial cells and matrix occurs. The same is observed with focal segmental glomerulosclerosis, but the picture is also supplemented by segmental scar tissue. Idiopathic nephrotic syndrome occurs at any age, more often - at the age of 2-6 years. A provoking factor may be a small infection or a mild allergy, or even an insect bite.
• Nephrotic syndrome with glomerulonephritis develops in about 75% of cases. It can be said that the development of the disease is a complication of the inflammatory pathology of the glomeruli. According to the variant of the course of the disease, there are:
  • acute glomerulonephritis with nephrotic syndrome (lasting less than three months);
  • subacute glomerulonephritis (lasts from three to 12 months);
  • chronic glomerulonephritis with nephrotic syndrome (symptomatology is increasing throughout the year, there is a high risk of formation of renal failure).
• Nephrotic syndrome in amyloidosis is one of the manifestations of systemic amyloidosis, in which protein-carbohydrate metabolism is disrupted, and amyloid is deposited in the kidney tissues, a complex polysaccharide-protein compound that causes organ organ derangement. The course of amyloidosis is always associated with the development of nephrotic syndrome with a further transition to the chronic form of renal failure.
• Nephrotic edematous syndrome is diagnosed with three mandatory components: changes in the permeability of the vessel walls, sodium retention, reduction in oncotic blood pressure. The pathogenesis of this syndrome is determined by the ratio of the activity of various body systems that regulate the maintenance of sodium-aqueous homeostasis.
• Nephrotic syndrome of the Finnish type is an autosomal recessive type of congenital pathology, which is detected starting from the period of the newborn to three months. Histology makes it possible to detect clear chain extensions of the proximal areas of the nephron and other changes, as well as many glomeruli with an overestimated diametrical size and fetal glomeruli. The reason for this pathology is a gene mutation (NPHS1 gene). The use of this term is explained by the high incidence of such a disease in Finland.
• The full type of pathology is characterized by a full set of symptoms typical for this disease. Incomplete nephrotic syndrome is accompanied by the absence of any typical trait - for example, pronounced proteinuria is diagnosed with minor swelling.
• Nephrotic syndrome in diabetes mellitus develops against a background of diabetic nephropathy. This pathological condition is considered very dangerous for the patient and consists of several stages: microalbuminuria, proteinuria and terminal stage of CRF. The development of the nephrotic symptom complex in this case is due to changes and disorders that usually occur in the long-term course of diabetes mellitus.
• Infantile nephrotic syndrome is a pediatric term, which means that the disease has appeared in a child whose age has not exceeded 1 year.
• Nephrotic syndrome in SLE is caused by the development of so-called lupus nephritis - one of the most dangerous and prognostically important manifestations of the disease. The mechanism of appearance of the disease refers to immunocomplex variants. The binding of antibodies to DNA and other autoantibodies to the basal membrane of the glomeruli of the kidneys leads to complement stimulation and the recruitment of inflammatory structures into glomeruli.
• Nephrotic syndrome with hematuria does not belong to the variants of the classical course of the disease. If a painful condition is accompanied by the appearance of blood in the urinary fluid, talk about a mixed form of pathology.

Depending on the reaction of the body to the conventional course of treatment with prednisolone, the nephrotic syndrome is divided into a steroid-sensitive and steroid-resistant form.

Steroid-sensitive syndrome is characterized by the onset of remission for 2-4 weeks (less often - 6-8 weeks) from the time of initiation of therapy. In turn, the steroid-sensitive form is divided into subcategories:

• non-recurrent type (complete, long-term remission);
• infrequently recurrent type (relapses are noted less often than 2 times in 6 months);
• often recurrent type (relapses are noted at least twice, than twice in six months);
• steroid-dependent nephrotic syndrome (repeat of the disease is observed against a background of a decrease in the dosage of prednisolone, or no later than two weeks after the drug was withdrawn);
• late-sensitive variant (remission comes after 8-12 weeks from the moment of the beginning of reception of steroids.

Steroid-resistant nephrotic syndrome is a course of the disease in which the body's response in the form of remission is absent during a full 2-month course of prednisolone.

[41], [42], [43], [44], [45], [46]

Complications and consequences

At a nephrotic syndrome there are various pathological changes in an organism. With prolonged existence, they can lead to the development of negative consequences, for example:

• Infectious complications are a consequence of both weakened immunity and an increase in the pathogenic susceptibility of the organism. Increase the risk of disease factors such as the loss of immunoglobulin with urinary fluid, a lack of protein, the use of immunosuppressors. Infectious complications can be triggered by streptococcal, pneumococcal, and other gram (-) bacteria. The most frequently recorded development of pathologies such as pneumonia, sepsis, peritonitis.
• Disturbance of fat metabolism, atherosclerotic changes, myocardial infarction - these complications are usually provoked by an increase in the level of cholesterol in the blood, acceleration of liver protein synthesis, a decrease in the lipase content in the blood.
• Violations of calcium metabolism, in turn, causes a decrease in bone density, a change in the structure of the bone, which is fraught with many problems. Presumably, this complication is provoked by loss of urine vitamin D-binding protein, deterioration of calcium absorption, as well as intensive treatment with steroid agents.
• Thrombotic complications are often diagnosed in patients with nephrotic syndrome. The increase in clotting is explained by the loss of urine of anticoagulant proteins of profibrinolysin and antithrombin III. At the same time, there is an increase in the factors of blood thickening. To avoid this complication, doctors advise taking anticoagulants during the first six months after the development of nephrotic pathology.
• Reduction in the volume of circulating blood occurs against hypoalbuminemia and a decrease in oncotic plasma pressure. Complication develops with a decrease in serum albumin to below 1.5 g / dl.

Among other, less frequent consequences of a nephrotic syndrome, can allocate a hypertonia, an iron deficiency anemia.

Recurrence of a nephrotic syndrome can develop with a steroid-dependent form of the disease. To prevent repeated episodes of the disease, patients undergo a detailed examination and carefully select the treatment taking into account all available options. The frequency of relapse depends on the severity of the disease, as well as on the general condition of the patient's body.

[47], [48], [49], [50], [51], [52]

Diagnostics of the nephrotic syndrome

The main diagnostic criteria for nephrotic syndrome are clinical and laboratory data:

• the presence of indicators of severe proteinuria (more than 3 g / day for adults, more than 50 mg / kg / day for children);
• indices of hypoalbuminemia less than 30 g / l, as well as disproteinemia;
• varying degrees of swelling (from relatively small edema to anasarca);
• gingival lipids and dyslipidemias;
• active coagulation factors;
• disturbed metabolism of phosphorus and calcium.

The survey, inspection and instrumental diagnostics are also mandatory and informative. Already during the examination, the doctor can pay attention to generalized puffiness, dry skin, the presence of a plaque on the tongue, a positive symptom of Pasternatsky.

In addition to medical examination, the next step should be such diagnostic procedures - both laboratory and instrumental.

Analyzes in the laboratory include the mandatory collection of blood and urine:

General blood test for nephrotic syndrome

The disease is characterized by an elevated level of platelets, leukocytes and ESR, a decreased level of hemoglobin.

Biochemical blood test for nephrotic syndrome

The quality of protein metabolism is characterized by hypoproteinemia, hypoalbuminemia, and an increase in the number of α-globulins. In addition, there is an increase in the level of cholesterol and triglycerides. Indicative for impaired renal function are increased levels of urea, uric acid, creatinine. If the cause of the nephrotic symptom complex is glomerulonephritis, the doctor will pay attention to the presence of signs of an inflammatory process (an increase in C-reactive protein, an increase in serumucoid levels, hyperfibrinogenemia).

Immunological blood test

It allows to fix the presence of T and B-lymphocytes, immunocomplexes, lupus cells in the bloodstream.

Hyperlipidemia in nephrotic syndrome may be an initial sign of the development of renal failure, but not always: sometimes it simply indicates the presence of atherosclerosis, or on certain problems with the patient's nutrition. Special laboratory studies can detect fractions belonging to lipids. These are low-density lipoproteins, high-density lipoproteins, an index of total cholesterol and triglycerides.

Hypercholesterolemia with nephrotic syndrome is secondary. In a healthy person, an elevated cholesterol level is indicated in the presence of> 3.0 mmol / liter (115 mg / dL). According to the recommendations of ESC / EAS, there is no indication of the level of cholesterol that determines hypercholesterolemia. Therefore, distinguish five specific ranges of the content of LDL-C, due to which the treatment strategy is determined.

Urinalysis total

The disease is characterized by cylindruria, hyperproteinuria. Erythrocytes in the urine can be detected, the specific gravity increases.

Bacteriological examination of urine

Helps identify bacteria found in urine (in the presence of bacteriuria).

A sample of Nechiporenko	There is an increase in the content of cylinders, leukocytes and erythrocytes.
The sample in Zimnitskiy	It allows to determine the hyperisostenuria and oliguria, characteristic for the nephrotic symptom complex.
A test for Reberga-Tareev	Oliguria and impaired glomerular filtration are noted.

Proteinuria is determined during a general urine test: the amount of protein usually exceeds 3.5 g / day. Urinary fluid is turbid, which serves as additional evidence of the presence in it of protein, pathogenic microorganisms, fats, mucus.

Instrumental diagnostics includes:

Kidney biopsy	It is carried out by sampling organ tissues for further microscopy. This procedure allows you to give a characterization of kidney damage.
Kidney ultrasound	It helps to consider the structure of organs, size, localization, the shape of the kidneys, to determine the presence of fever processes, cysts. Nephrotic syndrome on ultrasound is also characterized by the presence of ascites.
Radiography of the lungs	Disorders are pathological changes in the pulmonary system and mediastinum.
Dynamic scintigraphy	Allows you to assess the flow of urinary fluid from the kidneys in the ureters to the bladder.
Urology	Radiographic procedure based on the properties of the kidneys to remove special contrast agents after their introduction into the body. X-ray signs of nephrotic syndrome can be expressed in polymorphism and asymmetry of disturbances, which depends on the ratio of inflammatory and sclerotic processes in the organs.
Electrocardiography	It is carried out for evaluation of electrolyte disturbances in the body with nephrotic pathology.

[53], [54], [55], [56], [57], [58], [59], [60]

Differential diagnosis

Differentiation is carried out between different glomerulopathies, which, in turn, can cause the development of the disease:

• the disease of minimal changes (lipoid nephrosis) is the most common underlying cause of idiopathic nephrotic syndrome in pediatrics;
• focal-segmental glomerulosclerosis is a rare variety of steroid-resistant nephrotic syndrome;
• glomerulonephritis (including the membrane-proliferative form of the disease);
• membranous and IgA-nephropathy.

Acute pyelonephritis is characterized by a sudden increase in temperature to 38-39 ° C, a sudden appearance of weakness, nausea, edema. Cilindrarium, proteinuria, erythrocyturia are not considered specific for pyelonephritis symptoms, therefore, they are among the first indicative signs for conducting differential diagnosis.

Acute renal failure may develop as a complication of the nephrotic syndrome. Therefore, it is very important to notice the deterioration in a timely manner and provide the patient with appropriate medical assistance. The first stage of the development of OPN is characterized by increased heart rate, lower blood pressure, chills, fever. After 1-2 days oligoauna, nausea, vomiting are noted. Characteristic is also the ammonia odor of breathing.

Chronic renal failure is a consequence of the acute course of the disease and is accompanied by a gradual dying of the kidney tissue. The blood increases the amount of nitrogen metabolism products, the skin becomes dry with a yellowish tinge. At the patient the immunity sharply decreases: frequent ORZ, tonsillitis, pharyngitis are characteristic. The disease occurs with periodic improvements and worsening of the condition.

Differences between nephrotic and nephritic syndrome

There are two symptom complexes, the names of which are often confused: and, meanwhile, these are two completely different diseases that develop against the background of the inflammatory process in the glomeruli of the kidneys. The nephritic syndrome is usually provoked by an autoimmune structural lesion of the glomerulus. Such a condition in all cases is accompanied by an increase in blood pressure indicators, as well as signs of urinary pathology (urinary syndrome is characterized by such signs as erythrocyturia, proteinuria up to 3.0-3.5 g / liter, leukocyturia, cylinduria). The presence of edema is not mandatory, as in nephrotic syndrome, but they can be present - in the form of a mild swelling of the eyelids, forearms or fingers.

In the nephritic variant, puffiness does not result from a lack of proteins, but from the retention of sodium in the bloodstream.

[61], [62]

Treatment of the nephrotic syndrome

Treatment of patients with kidney disease and therapy of nephrotic syndrome is handled by a nephrologist. As a rule, patients are hospitalized to determine the cause of the disease, to provide emergency care, as well as when complications arise.

Prevention

To prevent the development of nephrotic disease, you must try to follow such rules:

• It is necessary to comply with the optimal mode of drinking liquids. You can drink ordinary clean water, green tea, compote of dried fruits or berries, cranberry or cranberry mors. A small inflow of fluid into the body can lead to the "fixing" of bacteria in the urinary system, as well as the formation of kidney stones.
• It is desirable to periodically drink herbal teas based on "kidney" herbs: parsley, bearberry, cranberry leaves, bear ears.
• In the appropriate season, it is necessary to pay enough attention to the use of birch sap, berries, vegetables and fruits (apples, cucumbers, zucchini, watermelons).
• Normal diets can be prevented by certain diets, especially strict mono-diets. Kidneys need a full and regular intake of both liquid and food.
• For kidneys, hypodynamia is disastrous. That's why you need to lead as far as possible an active way of life: walking, swimming, dancing, cycling, etc.

At any first signs of a malfunction from the kidneys, one should consult a doctor: one should not engage in self-medication (especially with the use of antibacterial and other powerful medications). Incorrect treatment can lead to the development of serious complications, which often remain with a person for life.

[63], [64], [65], [66], [67], [68], [69], [70], [71]

Forecast

The prognosis for nephrotic syndrome may be different, depending on the etiology of the disease. You can hope for a full recovery, if the symptom complex was a consequence of a curable pathology (for example, an infectious disease, a tumor process, drug intoxication). This is observed in about every second child, but in adults - much less often.

A relatively favorable prognosis can be said if a particular case of a nephrotic disease lends itself to hormonal therapy, or in immunosuppressive states. Individual patients experience an independent disappearance of relapses of pathology for five years.

In autoimmune processes, palliative treatment is predominantly performed. Diabetic nephrotic syndrome often approaches the final outcome in 4-5 years.

In any patient, the prognosis is able to change under the influence of infectious pathologies, against the background of increased blood pressure, with vascular thrombosis.

The nephrotic syndrome, complicated by renal insufficiency, has the most unfavorable course: the final stage may occur already for two years.

[72], [73], [74]