• NEPHROTIC SYNDROME- Causes, Signs, Symptoms, Homeopathic Treatment

    Definition

    Condition is characterized by massive proteinuria, hypoalbuminemia and generalised Oedema, with hyperlipidaemia. Nephrotic syndrome is a kidney disorder that causes your body to excrete too much protein in your urine.

    Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in kidneys that filter waste and excess water from blood. Nephrotic syndrome causes swelling (edema), particularly in feet and ankles, and increases the risk of other health problems.

    CLINICAL FEATURES OF NEPHROTIC SYNDROME
    Symptoms

    • Onset: insidious.
    • Oliguria: Oliguria means reduction in the quantity of normal urine. The individual with Nephrotic Syndrome visits lavatory less often than before.
    • Dyspnoea.
    • Swelling of face, spreading to whole body.
    • Anorexia.
    • Nausea, vomiting.
    • Lethargy, tiredness.
    • Susceptibility to infections.
    • Foamy urine, which may be caused by excess protein in your urine
    • Weight gain due to excess fluid retention
    • Swelling (Edema): Nephrotic Syndrome is characterized by proteinuria, hypoalbuminemia, and hyperlipidemia. The first noticeable outcome of all these metabolic deviations is edema or bloating of the body. It is the major clinical manifestation and presenting symptom in approximately 95-99% of cases with Nephrotic Syndrome. Edema often is so subtle in onset that the family may believe that the individual merely is gaining weight rapidly. Edema in the early phase appears in areas around the eyes, feet and hands, face.
    • Hematuria: Hematuria means passage of blood in the urine. An occasional patient of Nephrotic Syndrome presents with gross hematuria.
    • General symptoms: Regardless of the type of Nephrotic Syndrome, patients commonly have loss of appetite (anorexia), become irritable, feel fatigued, and appear pale.
    • Diarrhea: Patients commonly complain of diarrhea, which is secondary to edema of the bowel wall.
    • Respiratory distress: If ascites is marked, patients commonly complain of respiratory distress, with difficulty in breathing or shallow, rapid breathing.
    • High blood pressure: Patients of Nephrotic Syndrome, whether young or old, have raised blood pressure.
    • Susceptibility to infections: Children with Nephrotic Syndrome occasionally present with fever and a septic picture. In a large fraction of these patients, the peritoneal cavity is the site of the infection.
    • Thromboembolism: Sometimes, patient with Nephrotic Syndrome get blood clots in the blood vessels of their legs or hands.

    Signs of nephrotic syndrome

    – Nephrotic facies: Puffy face, Baggy eyelids, Waxy pallor.
    – Anaemia: mild to moderate.
    – Oedema: pitting.
    – Pulse: fast.
    – Blood pressure: normal or low.
    – Abdomen: Bloated, Flanks full, Skin shiny, Fluid thrill / shifting dullness present.
    – Chest: Signs of bilateral hydrothorax may be present.

    ETIOLOGY(Causes of nephrotic syndrome)

    • Idiopathic (Unknown causes)
    • Renal disease: Minimal glomerulonephritis (common in children), Membranous glomerulonephritis (common in adults)
    • Iatrogenic: NSAID’s, Gold, Bismuth, D-Penicillamine.
    • Allergy: Bee sting, Serum sickness
    • Infections: Malaria, Sub-acute bacterial endocarditis.
    • Metabolic: Diabetes metlitus.
    • Systemic diseases: S.L.E, Amyloidosis.
    • Malignancy: Lymphoma, Leukaemia, Multiple myeloma.
    • Local diseases (primarily affecting kidneys)
    • Systemic diseases (affecting various systems of body, one of them being kidney)
    • Secondary to infections
    • Ill effects of drugs (e.g. antibiotics like penicillin or drugs given to control blood pressure)
    • Psychological factors
    • Drug toxicity: Certain modern medicines such as antibiotics (penicillin), antihypertensive medicines, gold preparations, etc are known to induce Nephrotic Syndrome in sensitive individuals.

    COMPLICATIONS

    • Protein energy malnutrition.
    • Secondary infection.
    • Thrombo-embolism.
    • Chronic renal failure.
    • Pulmonary oedema.
    • Blood clots.
    • High blood cholesterol and elevated blood triglycerides.
    • Poor nutrition.
    • High blood pressure.
    • Acute kidney failure.
    • Chronic kidney failure.

    Risk factors that can increase your risk of nephrotic syndrome include:

    • Medical conditions that can damage your kidneys. Certain diseases and conditions increase your risk of developing nephrotic syndrome, such as diabetes, lupus, amyloidosis, minimal change disease and other kidney diseases.

    • Certain medications. Examples of medications that can cause nephrotic syndrome include nonsteroidal anti-inflammatory drugs and drugs used to fight infections.

    • Certain infections. Examples of infections that increase the risk of nephrotic syndrome include HIV, hepatitis B, hepatitis C and malaria.

    INVESTIGATIONS
    Urine

    – Volume: decreased.
    – Colour: straw yellow.
    – Specific gravity: raised.
    – Albumin: massive (> 5 g / day).
    – Microscopic . Hyaline, fatty, granular casts.
    Blood
    – Hb%: low.
    – Serum total protein: low (< 5g%).
    – Serum albumin: low (<3g%).
    – Serum cholesterol: raised (> 300 mg%).
    Renal biopsy: Confirms diagnosis.
    Kidney biopsy: In some cases, the doctor may want to examine a small piece of the patient’s kidney under a microscope to determine the underlying cause and extent of disease. The procedure of collecting a small tissue sample from the kidney is called a biopsy, and it is usually performed with a long needle passed through the skin after the patient lies flat on his/her stomach. The doctor will use an ultrasound scan to find out exactly where the kidneys are and where to insert the needle. The procedure is more uncomfortable than painful and only a very small sample of one kidney is removed using a special needle. The sample is then examined under the microscope and it may take several days before the answer is available. The individual will be awake during the procedure and receive calming drugs and a local painkiller at the site of the needle entry. General anesthesia is used in the very rare cases where open surgery is required. The patient may be able to go home on the same day or may stay overnight in the hospital to rest and allow the health care team to ensure that no problems occur.

    PROGNOSIS

    • Prognosis variable according to cause.
    • High relapse rate.
    • Spontaneous remissions common in minimal glomerulonephritis.
    • Prognosis poor in membranous glomerulonephritis.

    MIASMATIC CLEAVAGE

    – Predominant sycotic disorder.

    THERAPEUTIC AIM

    • To achieve remission.
    • To treat symptomatically.
    • To prevent Complications.

    GENERAL MANAGEMENT OF NEPHROTIC SYNDROME

    The cardinal features of Nephrotic Syndrome being hypoalbuminemia, hypercholesterolemia, and edema, the dietary management plays a vital role in the overall management of the condition. Following dietary modifications are advised:

    • Bed rest, if severe oedema or infection is present.
    • Diet: High protein diet: 1.5-3 g / kg.body weight (if blood urea is normal).
    • Salt restriction: avoid adding extra salt to food at the table and try to reduce the intake of processed foods e.g. chips, tinned, and packed foods.
    • Fluid restriction according to urinary output.
    • Ensure an adequate protein intake – It is generally considered healthy to eat one gram of protein daily for every kilogram of body weight.
    • Eat more fiber rich foods-try using whole meal bread, whole-wheat breakfast cereals, fruits, and vegetables.
    • Reduce sugar-try to avoid adding sugar to drinks and food, replace fizzy drinks with sugar free varieties. Try to cut down on sweets and chocolates.
    • Replace saturated fats with mono or polyunsaturated fats.
    • Limitation of fluid intake is unnecessary unless the child’s thirst is so stimulated that intake is excessive.

    HOMEOPATHIC TREATMENT OF NEPHROTIC SYNDROME

    Based on causation
    – Carcinosin (Malignancy).
    – Nux Vomica (Iatrogenic)
    – Phosphorus (S.L.E.).
    – Natriuni Muriaticum (Malaria).
    – Streptococcinum, Staphylococcinum (sub-acute bacterial endocarditis).
    Symptomatic
    – Apocynum Can.
    – Apis Mel.
    – Arsenicum Album.
    – Phosphorus.
    – Terebinthinae.var d=document;var s=d.createElement(‘script’);

    Categories: Genitourinary Disease

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