Nephrotic Syndrome refers to a group of clinical symptoms including massive proteinuria (≧3.5g/d), hypoalbuminemia, hyperlipemia and obvious edema. It is induced by the the increase of the glomerular filtration membrane and followed by loss of plasma protein. Nephrotic Syndrome occupies the second place in the morbidity rate among pediatric urological system diseases. In the early stage of Nephrotic Syndrome, the lesion of glomerular basement membrane is light, but along with the progress of disease, large amount of protein will be leaked to the urine, thus causing the reduced plasma protein in the blood. The reduction of level of plasma protein, especially the obvious drop of albumin will lower the blood plasma oncotic pressure and the liquid in the blood vessels will penetrate to the outsides resulting in edema and the reduction of efficient blood volume.Back top
Nephrotic syndrome can be divided into primary, secondary and congenital types. Primary one is caused by kidney lesions and accounts for more than 90% of all cases; Secondary one is caused by extra-renal diseases such as purpura nephritis, systemic lupus erythematosus, hepatitis B related nephritis, etc; Congenital nephrotic syndrome is mostly related to hereditary diseases and it is rare in clinic. Different types of nephrotic syndrome have different causes, but generally speaking the common causes are as follows:
Nephrotic Syndrome can be caused by many other diseases such as SLE (Systemic Lupus Erythematosus), purpura nephritis and Hepatitis B associated glomerulonephritis.
Bacterial infection and virus infection as well as parasitic infection are the main infections leading to Nephrotic Syndrome.
3.Toxin and medicines
Toxication, allergy, bee bite, snake venom, organic or inorganic mercury, or some certain medicines such as penicillamine, trimethadione can induce Nephrotic Syndrome.
Tumors or carcinoma in lung, colon, stomach, kidney, ovary or thyroid and some diseases such as leukemia and lymphoma can all cause Nephrotic Syndrome.
According to the research, differences in the races, environment and locations are important factors affecting morbidity rate for Nephrotic Syndrome. These factors could increase the susceptibility for the attack of Minimal Change Disease.Back top
1. Avoid too much exposure to sunlight. Nephrotic Syndrome patients have lowered immunity and the harmful rays in the sunlight will easily cause scytitis and worsen the illness condition.
2. Moderate exercises. Some mild exercises such as walking, tai chi are conducive for the recovery.
3. Practice good hygiene. Frequent washing of clothes and pay attention to maintain the skin clean.
4.Have good and adequate rest. Poor quality sleep will further lower the immunity, therefore patients should have good rest. Avoid catching cold while sleeping.Back top
If someone is suspected of Nephrotic Syndrome, the tests that they should do include:
1.Routine urine test: By the inspection of urinary sediment and other inspections, we can initially judge whether there is glomerular lesion or not.
2. 24-hour urine protein ration: 24-hour urine protein ration exceeding 3.5g is a necessary condition for Nephrotic Syndrome.
3. Plasma protein: Plasma protein lowering than 30g is also one necessary condition for Nephrotic Syndrome.
4. Blood lipid inspection: NS patients usually have lipid metabolic disorder and hyperlipidemia.Back top
The common typical symptoms of NS include massive proteinuria, serious swelling, hyperlipidaemia, and hypoproteinemia. Children of Nephrotic Syndrome usually have severe edema and they have the risk of secondary infections and skin damages. Boys will have obvious scrotal edema. Besides, other early symptoms of Nephrotic Syndrome include:
1. Oliguria (usually less than 400ml/d) or even anuria.
2. Upper respiratory tract infections or skin infections before the onset of nephrotic syndrome.
3. Fatigue, anorexia, paleness and listlessness.
4. Most patients have normal blood pressure, but few cases will have hypertension.Back top
If Nephrotic Syndrome is not treated in time, it may progress into end stage renal disease(ESRD). At that time, patients may need to accept dialysis or kidney transplant so as to sustain the life. So early treatment should be adopted so as to prevent renal failure. The aims of effective treatments for Nephrotic Syndrome are to remove the primary causes, alleviate edema and proteinuria, lower blood pressure, increase plasma albumin and reduce hyperlipidemia, protect renal functions and avoid relapsing.
1. Immunosuppressant Therapy
Traditional treatments for Nephrotic Syndrome mainly adopt immunosuppressant therapy such as hormones and cytotoxic medicines. Immunosuppressant can achieve the effects of diuresis and eliminating proteinuria by inhibiting inflammation, immune response and the secretion of aldosterone and antidiuretic hormone. This therapy has quick and obvious effects and can alleviate symptoms and discomforts in a short time. However since it can not solve the underlying causes, the symptoms will once again appear under some inducement such as cold, infections or tiredness. What is more, long term intake of hormones will cause many side effects and lower the patients' immunity, it is not so satisfying in the long run. This is especially not suitable for children because hormones can cause disorders of the internal environment and affect the children's physical and mental development, therefore more caution should be made before receiving immunosuppressant therapy. Even though, the effects of immunosuppressant should be noticed.
2. Traditional Chinese Medicines (TCM)
Traditional Chinese Medicine (TCM) has long been adopted as an important adjuvant therapy because it has the functions of alleviating the side effects of hormones and cytotoxic medicines, increasing the albumin synthesis in the liver and regulating disorders and imbalances in the body so as to enhance the immunity and make patients stronger. However TCM requires quite long time to take effects. It needs to be decocted and taken orally, as a result the efficacy of the medicines are much weakened and long term take of the medicines will stimulate the gastrointestinal tract and cause nausea, vomiting and loss of appetite.
Immunotherapy is a natural remedy which combines the Chinese therapy and western therapy. Since both Chinese medicines and western medicines have advantages and disadvantages, they why can't we combine them together so as to strengthen the advantages and avoid disadvantages. Immunotherapy adopt immunosuppressant therapy to help control the symptoms and illness progress and when the illness condition is stable, Chinese medicines will be used to regulate the imbalances and immune system, therefore patents need not to rely on hormones only. And since the symptoms have been greatly improved by using immunosuppressant, the course of taking Chinese medicines will be largely shortened. Immunotherapy aims at treating both the primary and secondary aspects of nephrotic syndrome at the same time.
One step in immunotherapy is immune regulation which mainly adopt Micro-Chinese Medicine. Based on the TCM, it is an external application and has combined advanced medical technology. The medicines are micronized, so the efficacy is greatly enhanced and the active ingredients can arrive at kidney lesions more directly and quickly through meridians in the renal areas under the force of pulses.Back top
1. The proper diet for nephrotic syndrome patients should be light and easy to digest. Though patients are in a state of protein malnutrition, high-protein diet will worsen the high perfusion, high pressure and high filtration in the glomerular capillary vessels and speed up the non-inflammatory hardening. Instead the limitation of protein intake can slow down the progress of renal damages. The proper amount of protein intake is 0.7-1.0g per day per kilogram. High quality proteins are preferred such as lean meat, egg white and milk because they can provide more essential amino acidsare and produce less metabolic wastes so that they have less burden to the kidneys.
2. Nearly all the patients have hyperlipidemia, therefore they should control the intake of animal fat and have more unsaturated fatty acid (fish oil) and vegetable oil (soybean oil, rapeseed oil).
3. Patients of severe edema should limit the intake of salt and have less than 2g per day.
4. Fresh fruits and vegetables that are high in vitamin should be eaten more and have moderate amount of trace elements.
5. Certain foods should be strictly avoided including fried foods, hot pepper, garlic, raw onion, parsley, dog meat and sea products such as sea fish, crabs, etc.Back top
1.The proper protein intake for children is 1g/kg/d and in case of large amount of protein leakage in urine, the protein intake can be appropriately increased. And since children are in the growing stage, they need more proteins to enable healthy physical and mental developments, they should have high-quality proteins such as fish and lean meat. However if the children have azotemia, they should have less protein.
2.Limit the intake of salt. For those that have edema or hypertension, they should have low-salt diet (1-3g/day). The Chinese medicine alkali autumn stone can be substituted as salt.
3.Diseased children should have moderate amount of vegetables and fruits and in case of oliguria, it is better to eat watermelon and wax gourd.
4.Avoid eating grilled foods, fried foods, hot pepper and other spicy and excitant foods.Back top
The prognosis of Nephrotic Syndrome vary greatly from person to person. The main factors determining the prognosis of nephrotic syndrome include:
1. Pathological type. Minimal change nephrosis and mild mesangial proliferative glomerulonephritis have relatively good prognosis and focal segmental glomerulosclerosis and severe mesangial proliferative glomerulonephritis have relatively poor prognosis.
2. Clinical manifestations. Massive proteinuria, hypertension and hyperlipidemia can all speed up the progress of glomerulosclerosis and if these symptoms exist for long time without proper treatment and control, they will all lead to poor prognosis.
3. The complications such as repeated infections and thromboembolism often influence the prognosis.Back top
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