Definition
Nephrotic syndrome is a kidney disease where the body passes an excessive quantity of protein in the urine. It is characterized by a combination of nephrotic proteinuria and a low serum albumin concentration. It is characterized as nephrotic proteinuria when a person has a daily loss of more than three grams of protein in a single urine spot. Most patients are not usually aware that they have nephrotic syndrome in the early stages until regular blood and urine tests are conducted (1). Depending on the results of the tests, one may have an inadequate amount of protein in their blood, an excessive amount of protein in their urine, or an excessive amount of fat in their blood.
Potential causes of nephrotic syndrome
One of the potential causes is diabetic nephropathy. This is a chronic kidney condition that may occur in persons who have diabetes. It happens when excessive blood glucose levels damage a person’s kidneys. The other cause is minimal change disease. This is most common in children under the age of four. Even though this disease is the leading cause of NS in children, the kidney tissue appears normal when examined under a microscope (2). Normally, the kidneys remove waste products from the blood accumulated over time due to normal bodily functions. To do this, they must filter all of the blood in the body numerous times every day. Urine is the blood that has been filtered, and that is precisely what fails when one has membranous nephropathy. If the kidneys function correctly, they should filter out this blood without losing any of the proteins that are anticipated to remain in circulation. It is possible for a protein to get past the kidney filters and end up in the urine, which signifies Nephrotic syndrome.
Another possible cause is a condition known as Membranous Nephropathy. It is known as membranous nephropathy because your immune system attacks your kidneys’ filtering cells, causing them to malfunction and lead you to excrete a large amount of protein in your urine. If the levels stay elevated for an extended period, this may eventually result in renal failure (3). A buildup of thicker membranes inside the glomeruli is the root cause of this kidney disease. The immune system’s deposits are responsible for the thickening of the skin. Several medical conditions, such as hepatitis B virus, lupus, or malaria, may be associated with this condition, although it may also occur for no apparent reason. Another possible cause is focal segmental glomerulosclerosis. It is an uncommon condition that affects the kidneys’ filtering units (glomeruli), creating extensive scarring that may result in permanent kidney impairment and, in extreme cases, renal failure (4). This condition, which is associated with scarring of kidney sections, may be caused by a genetic aberration or particular medicines, or it may occur for no apparent reason.
Clinical features
Key clinical features of Nephrotic syndrome include high blood pressure, weight gain as a result of fluid retention and swelling in the hands and feet. Patients suffering from NS also experience fever, elevated white blood cell count, urine that appears foamy as a result of protein loss from the body into voided urine, and pain as a result of blood clots (5).
Pathological features
Under light microscopy, membranous nephropathy is characterized by immune sediments on the glomerular basement membrane, which are frequently associated with mesangial hypertrophy: the immune deposits are irregular and are ingrained in the membrane expansions. The pattern of parietal granular sediments in membranous nephropathy shown with florescence microscopy is distinct from the more diffuse pattern observed under light microscopy. Membranous nephropathy and basement membrane reaction appears as spikes on Jones silver stain when observed under an electronic microscope.
Conclusion
The major cause of nephrotic syndrome (NS) is impairment to glomeruli, which filter excess water and waste from the blood as part of their normal function. Swelling develops, especially in the ankles, and the condition intensifies the chance of having other health concerns. Despite the fact that there is no cure for nephrotic syndrome, a physician can prescribe particular drugs to reduce symptoms and prevent more kidney damage from developing. Changing food choices can also be beneficial in the treatment of the condition.
References
- Agrawal, S., Zaritsky, J. J., Fornoni, A., & Smoyer, W. E. (2018). Dyslipidaemia in nephrotic syndrome: mechanisms and treatment. Nature Reviews Nephrology, 14(1), 57-70. Retrieved from https://www.nature.com/articles/nrneph.2017.155
- Bensimhon, A. R., Williams, A. E., & Gbadegesin, R. A. (2019). Treatment of steroid- resistant nephrotic syndrome in the genomic era. Pediatric Nephrology, 34(11), 2279-2293. Retrieved from https://link.springer.com/article/10.1007/s00467-018- 4093-1
- Kemper, M. J., & Lemke, A. (2018). Treatment of genetic forms of nephrotic Frontiers in pediatrics, 6, 72. Retrieved from https://www.frontiersin.org/articles/10.3389/fped.2018.00072/full
- Preston, R., Stuart, H. M., & Lennon, R. (2019). Genetic testing in steroid-resistant nephrotic syndrome: why, who, when and how?. Pediatric nephrology, 34(2), 195-210. Retrieved from https://link.springer.com/article/10.1007/s00467-017-3838-6
- Fogo, A. B., Lusco, M. A., Najafian, B., & Alpers, C. E. (2015). AJKD Atlas of renal pathology: membranous nephropathy. American Journal of Kidney Diseases, 66(3), e15-e17. Retrieved from https://www.ajkd.org/article/S0272-6386(15)00945-2/fulltext
- Mühlig, A. K., Lee, J. Y., Kemper, M. J., Kronbichler, A., Yang, J. W., Lee, J. M., … & Oh, J. (2019). Levamisole in children with idiopathic nephrotic syndrome: clinical efficacy and pathophysiological aspects. Journal of Clinical Medicine, 8(6), 860. Retrieved from https://www.mdpi.com/2077-0383/8/6/860
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