Nephrotic syndrome is not a disease by itself but is an important feature of several kidney diseases. And the main characteristic of this nephrotic syndrome is Marked proteinuria which is more than 3.5 grams per day, Hypoalbuminemia, General edema, and Hyperlegidemia. The normal kidney has about 1 to 2 million nephrons. And the glomerular structure has the fenestrated endotherium, glomerular basement membrane, and the protozoites. And there are two types of barriers in this nephron, which is the size barrier and the negative charge barrier.
Usually, the glomerulus only lets small molecules such as sodium and water to pass through urine, but does not allow bigger molecules or negatively charged molecules such as the proteins to pass through the membrane. In nephrotic syndrome, the glomerulus is damaged and becomes more permeable, letting plasma proteins to leak into urine. The leakage causes proteinuria, which is greater than 3.5 grams per day.
Nephrotic syndrome can be classified into two types. that is the primary nephrotic syndrome being a disease specific to the kidneys or can be secondary being a random manifestation of a systemic general illness the causes of primary nephrotic syndrome include minimal change nephropathy with the most common cause in children focal glomerulosclerosis membranous nephropathy and hereditary nephropathies then in secondary nephrotic syndrome the causes include diabetes mellitus which is diabetic nephropathy laparothematosis viral infections such as hepatitis B, C, and human immunodefinite virus, amyloidosis and paraprotein amyos, together with preeclampsia, and alloantibodies from enzyme replacement therapy. The plasma protein, which is bigger than 70 nanomiles, is restricted from passing through the glomerulus basement membrane by a charge-sized barrier. The charge-selective barrier, such as heparin cells within the glomerulus basement membrane, restricts the passage of Small polyanion plasma proteins most commonly the albumin and albumin is the main protein loss because it is the most common and It's the smallest of the plasma proteins when there is a loss of charge selectivity like neutralizing charges in Minimal change chromatin nephropathy the albumin can leak out into urine causing hypoalbuminemia and albuminuria loss of albumin to urine causes hypoalbuminemia, lowering plasmoncotic pressure, making the extracellular fluid to start seeping out of the intravascular compartment causing hypovolemia.
And this hypovolemia causes lowered kidney perfusion, stimulating activation of renin-angiotensin aldosterone system. Then this RBA system enhances distal renal tubular sodium reabsorption. But since the fluid cannot be held in the vascular compartment, it leaks again out of the tissues.
leading to development of pitting edema. In severe cases, hypoalbuminemia can cause hypopalemia with pre-run or failure. And this edema in nephrotic syndrome will start around the eyes as perioperative edema because the skin around the eyes is loosely attached to the bones and muscles, then spreads to the body causing general edema which is known as anusaka.
Then the loss of small cells proteins such as Immunoglobulins to Uline causes low levels of IgG levels and loss of Bacter B, causing the alternate pathway of complement activation to be compromised, which therefore leads to low immunity and susceptibility to infections. Loss of thyroxine binding proteins, 25OH-cholesterol binding globulin and transferrin leads to impaired ion transportation, which causes iron deficiency in these patients with nephrotic syndrome and loss of antithrombin 3 which is an anticoagulant urine but fibrinogen is not lost because a big molecule so you have high levels of fibrinogen in blood and these high levels will cause hypercoagulation of blood therefore making these patients with nephrotic syndrome to be at risk of thrombosis because of hyperviscosity blood There is also an increased hepatic synthesis of cholesterol, triglycerides and lipoproteins, which causes hyperlipidemia. And an increased urinary loss of high density lipoproteins causes lipuria. The differential diagnosis when you come across this patient with features of nephrotic syndrome will be acute glomerulonephritis, acute renal failure, chronic renal failure, quashia core, allergic reactions, congestive cardiac failure, liver disease with hypoalbuminemia, and protein-losing enteropathies.
The investigation you conduct during your diagnosis will include urinalysis, which will indicate hematuria and proteinuria. complement C3 levels, and urine segment examination, urinary protein measurement, serum albumin, serologic studies for infections and immune abnormalities, together with renal arthrosomography and renal biopsy. Then the management will include dietary management, normal protein diet as per nutritional status of the patient, and high protein diet will increase protein synthesis, but will increase albumin excretion, rather than plasma albumin levels.
Low salt intake if obese due to steroids, control the calorie intake. The medication will include corticosteroids such as prednisone, immunobolylethers such as cyclophosphamide and cyclosporine used to induce remission of nephrotic syndrome. Duratics such as furosemide and spironodactyl which is a potassium-sparing duratic is used to relieve the edema. and angiotensin-converting enzyme inhibitors such as tapetopril, enalapril and lisinopril plus angiotensin-2 receptor blockers such as losotan and valsotan can be used to reduce protein immunity.
You'll have to manage complications such as hypertension by using short-term treatment with nifedipine and hydralazine, but you can also add a tendrilol to aid of them. You prevent trombosis by encouraging mobilization of the patient and psychological support. then you manage the infections using prophylactic antibiotic benicillin b in patients with gross ascites septicemia or peritonitis and you can add first generation super sporeins or clove zazen and flucloclazanine together with that generation's spores pollens you manage hyper bulimia using albumin infusion thank you and hope you have enjoyed that tutorial consider subscribing to our channel for future tutorials