NEPHROTIC SYNDROME

Dictionary Meaning -

(according to Dorland's pocket medical Dictionary)

Nephrotic - Pertaining To, Resembling, Or Caused By Nephrosis.

Nephrosis - 1. Nephropathy. 2. Any Kidney Disease Characterised By Purely Degenerative Lessions Of The Renal Tubules. 

Syndrome - A Set Of Symptoms Occurring Together; The Sum Of Signs Of Any Morbid State; A Symptom Complex.

Pathological Point Of View -

• Nephrotic Syndrome Is A Nonspecific Kidney Disorder Characterised By A Number Of Signs Of Disease: Proteinuria, Hypoalbuminemia And Edema. 

Signs & Symptoms :-

• It Is Characterized By Proteinuria (>3.5g/day), Hypoalbuminemia, Hyperlipidaemia, And Edema (Which Is Generalized And Also Known As Anasarca Or Dropsy) That Begins In The Face.

• Lipiduria (Lipids In Urine) Can Also Occur, But Is Not Essential For The Diagnosis Of Nephrotic Syndrome. 

• Hyponatremia Also Occurs With A Low Fractional Sodium Excretion.

A Few Other Characteristics Seen In Nephrotic Syndrome Are:

• The Most Common Sign Is Excess Fluid In The Body Due To The Serum Hypoalbuminemia. Lower Serum Oncotic Pressure Causes Fluid To Accumulate In The Interstitial Tissues. Sodium And Water Retention Aggravates The Edema. This May Take Several Forms:
  • Puffiness Around The Eyes, Characteristically In The Morning.
  • Pitting Edema Over The Legs.
  • Fluid In The Pleural Cavity Causing Pleural Effusion. More Commonly Associated With Excess Fluid Is Pulmonary Edema.
  • Fluid In The Peritoneal Cavity Causing Ascites.
  • Generalized Edema Throughout The Body Known As Anasarca.
• Most Of The Patients Are Normotensive But Hypertension (rarely) May Also Occur.
• Anaemia (iron resistant microcytic hypochromic type) Maybe Present Due To Transferrin Loss.
• Dyspnea May Be Present Due To Pleural Effusion Or Due To Diaphragmatic Compression With Ascites.
• Erythrocyte Sedimentation Rate Is Increased Due To Increased Fibrinogen & Other Plasma Contents.
• Some Patients May Notice Foamy Or Frothy Urine, Due To A Lowering Of The Surface Tension By The Severe Proteinuria. Actual Urinary Complaints Such As Haematuria Or Oliguria Are Uncommon, Though These Are Seen Commonly In Nephritic Syndrome.
• May Have Features Of The Underlying Cause, Such As The Rash Associated With Systemic Lupus Erythematosus, Or The Neuropathy Associated With Diabetes.
• Examination Should Also Exclude Other Causes Of Gross Edema — Especially The Cardiovascular And Hepatic System.
• Muehrcke's Nails; White Lines (leukonychia) That Extend All The Way Across The Nail And Lie Parallel To The Lunula.

Pathophysiology :-

• The Renal Glomerulus Filters The Blood That Arrives At The Kidney. It Is Formed Of Capillaries With Small Pores That Allow Small Molecules To Pass Through That Have A Molecular Weight Of Less Than 40,000 Daltons, But Not Larger Macromolecules Such As Proteins.

• In Nephrotic Syndrome, The Glomeruli Are Affected By An Inflammation Or A hyalinization (the formation of a homogenous crystalline material within cells) That Allows Proteins Such As Albumin, Antithrombin Or The Immunoglobulins To Pass Through The Cell Membrane And Appear In Urine.

• Albumin Is The Main Protein In The Blood That Is Able To Maintain An Oncotic Pressure, Which Prevents The Leakage Of Fluid Into The Extracellular Medium And The Subsequent Formation Of Edemas.

• As A Response To Hypoproteinemia The Liver Commences A Compensatory Mechanism Involving The Synthesis Of Proteins, Such As alpha-2 macroglobulin And lipoproteins. An Increase In The Latter Can Cause The Hyperlipidemia Associated With This Syndrome.

Drawing of the renal glomerulus.

Classification :-

A Broad Classification Of Nephrotic Syndrome Based On Underlying Cause:

Nephrotic syndrome

Primary

Secondary

Nephrotic Syndrome Is Often Classified Histologically:

Nephrotic syndrome

MCD

FSGS

MN

MPGN

For More Details :-

• http://en.wikipedia.org/wiki/Nephrotic_syndrome

Management :-

Allopathic Treatment :-

Symptomatic Treatment :-

• Edema - Rest, Medical Nutrition Therapy, Diuretics. 

• Hypoalbuminemia - Medical Nutrition Therapy. 

• Hyperlipidaemia -  Medical Nutrition Therapy, Hypolipidemic Drugs. 

• Thrombophilia - Low Molecular Weight Heparin Can Be Useful As A Prophylactic. 

• Infectious Complications - Antibacterial Drugs. 

• Treatment Of Kidney Damage - Cortico Steroids, Immuno Supressors.

 Homoeopathic Treatment :- 

" One Single Simple Drug Substance In Its Most Suitable Potency, According To Symptom Similarity Based On Totality! "

Some Useful Remedies Are :-

• Aconite

• Apis mellifica

• Apocynum

• Arsenicum

• Aurum muriaticum

• Belladonna

• Cantharis

• Convallaria

• Cuprum arsenicum

• Digitalis

• Glonoine

• Kali chloricum

• Mercurius corrosivus

• Plumbum

• Phosphorus

• Terebinth

For More Details -

• http://treatment.hpathy.com/homeo-medicine/homeopathy-nephrotic-syndrome/ 

Our Next Topic Is "Diabetes".

I Need Your Help For More Precise Work........You Can Submit Your Work At ktthebest4u@gmail.com  ; Last Day Of Submission Will Be Saturday, 30/8/2014.

Take Care Of Your Body,

It's The Only Place You Have To Live In.

With Best Regards, Karnav Thakkar :) :)