Virtual Medical Centre

Nephrotic Syndrome (NS)

• What is Nephrotic Syndrome?
• Who gets Nephrotic Syndrome?
• Predisposing Factors
• Progression
• Probable Outcomes
• How is Nephrotic Syndrome Diagnosed?
• How is Nephrotic Syndrome treated?
• Nephrotic Syndrome References
• Drugs/Products Associated with Nephrotic Syndrome

What is Nephrotic Syndrome?

Nephrotic Syndrome (NS) is a disease affecting the kidneys.

Exclusively associated with the excessive loss of albumin into the urine generally defined to be exceeding 3.5g per day.

Who gets Nephrotic Syndrome?

Difficult to estimate due to wide cross section of renal disorders being associated with its occurrence. Minimal change disease accounts for three quarters of childhood cases and this occurs in 15 per 100,000 children. The incidence in adults is also dependent on the cause and thus will vary with the incidence of the particular diseases in the population.

Predisposing Factors

Nephrotic syndrome has a vast number of causes.

They are classified as primary (causes that primarily affect the glomerulus of the kidney) and secondary (known conditions whose affect on the kidney is part of their spectrum of disease. The primary causes are designated according to their microscopic appearance, for little is known about their specific origin. The secondary causes are designated by disease name, for the nephrotic syndrome occurs with the existence of that disease.

The primary diseases include minimal change disease, focal segmental glomerulosclerosis, membranous glomerulopathy, proliferative glomerulonephritis and membranoproliferative glomerulonephritis.

The secondary diseases include various infections, drugs/toxins (non-steroidal anti-inflammatories, gold salts, heroin, heavy metals, bee stings, pollens, tumour associated antigens), collagen-vascular diseases, diabetes mellitus, amyloidosis, light chain nephropathy, chronic vesicoureteric reflux, pregnancy, and obesity.

Progression

Prior to the development of immunosuppression therapy, nephrotic syndrome resolved in one of three ways.

1. Patients experienced the complications of nephrosis: Immunoglobulin loss in the urinary protein increased susceptibility to infection. The balance of clotting factors in the blood is also altered by this condition increasing the risk of developing clots in affected patients.

2. Renal toxicity: The longer and greater the loss of protein in the urine, the quicker the kidney develops glomerulosclerosis and fails.

3. The development of chronic renal failure.

Careful attention to the glomerulopathy with steroids and to the complications with drugs such as angiotensin converting enzyme inhibitors have substantially improved the prognosis and prolonged the functional life of the kidney.