What causes nephrosis

Nephrotic Syndrome

Nephrotic Syndrome: Combination of water retention, loss of body protein with the urine and protein deficiency in the blood due to acute or chronic kidney damage. The triggers are various acute or chronic (kidney) diseases. If the cause can be eliminated, the nephrotic syndrome usually also disappears. Children who have developed nephrotic syndrome from glomerulonephritis have a particularly good prognosis. Patients with anti-basement membrane glomerulonephritis and diabetics have poorer prospects. With them, the nephrotic syndrome often leads to chronic kidney failure with dialysis obligation.

Leading complaints

  • Edema, especially in the legs (ankles), arms, and face (eyelids)
  • Weight gain due to the water retention
  • Foamy urine
  • Tendency to thrombosis (blood clots)
  • High blood pressure
  • Susceptibility to infection.

This 38 year old patient went to the doctor because of her swollen face. This diagnosed a nephrotic syndrome - also because of the facial edema.
Georg Thieme Verlag, Stuttgart

When to the doctor

In the next few days at

  • Water retention in arms, legs, or face
  • unexplained weight gain
  • foamy urine.

The illness

Disease emergence

With the kidney corpuscles, healthy kidneys have a filter system that removes large molecules such as B. Retains proteins and lets water and smaller substances (e.g. minerals) through. Proteins behave in the blood vessels like a sponge that absorbs and binds water, thus ensuring that the water balance of blood vessels and body tissue remains in balance. In nephrotic syndrome, "leaks" occur in the kidney's filter system. These leaks cause large amounts of protein to be lost in the urine. It is these proteins that make the urine frothy. As a result of the severe protein loss, fluid moves from the blood vessels into the body tissue, which leads to edema in the legs, arms and face. The water retention is often the first noticeable on the eyelids, as the connective tissue on the eye is particularly loose.

Other consequences of nephrotic syndrome result from the loss of important proteins via the kidneys:

causes

In ~ 75% of cases, the nephrotic syndrome arises as a result of glomerulonephritis. Other causes are long-term damage to diabetes such as diabetic nephropathy, but also nephrosclerosis and amyloidosis.

Diagnostic assurance

The easiest way to detect protein in the urine is with a urine test strip. For a more detailed examination, the doctor will use various urine and blood tests:

  • Urine tests
    • 24-hour urine collection: measurement of the excreted total protein (a value below 150 mg is normal, in nephrotic syndrome more than 3000 mg / 24 are excreted)
    • Protein electrophoresis: testing the composition of the proteins in the urine. The size and type of proteins give the doctor information about kidney damage
    • Urine sediment: microscopic examination of the solid constituents of urine for protein and fat cells in cylinders and cells
  • Blood tests

On the ultrasound, the doctor often recognizes enlarged kidneys with compressed kidney tissue. In most cases, a kidney biopsy is also necessary for an accurate diagnosis.

treatment

Basically, the doctor always tries to eliminate both the symptoms and the underlying cause of the nephrotic syndrome so that the kidneys are not permanently damaged. Treating the causes includes setting up diabetes optimally, fighting a kidney infection, or stopping harmful medication. In the case of an autoimmune disease, cortisone or a stronger immunosuppressive therapy with cyclophosphamide or cyclosporine is used.

General therapeutic measures:

  • Low-salt diet, but no protein restriction. The protein intake should be around 1 g protein / kg body weight per day.
  • Diuretics (water tablets) to flush out the edema
  • Medicines to lower high blood lipids, especially CSE inhibitors (statins)
  • ACE inhibitors or AT1 antagonists for high blood pressure. ACE inhibitors and AT1 antagonists also reduce the increased protein excretion.
  • Vitamin D supplements for vitamin D deficiency
  • Anticoagulant drugs for thrombosis prophylaxis.

forecast

The prognosis depends on the underlying disease. Minimal-change glomerulonephritis has a particularly good prognosis; over 90% of cases heal with cortisone administration. Many other diseases with a nephrotic syndrome lead in the long term to renal insufficiency that requires dialysis.

Your pharmacy recommends

What you can do yourself

Make sure you have an adequate protein intake. If you consume too little protein, the body breaks down more muscle mass. Clarify with your doctor how much protein is optimal for you each day. As a rule, 0.8 to 1 g / kg body weight is recommended.

Reduce table salt. As a type 2 diabetic, you should limit your intake of table salt (sodium chloride) with your food to a maximum of 6 g per day. Studies have shown that a low-salt diet can significantly reduce increased protein excretion in the urine and thus reduce the risk of kidney damage.

6 g table salt is roughly equivalent to a level teaspoon full of salt. According to the German Nutrition Society, table salt intake is currently too high for around 70% of women and around 80% of men. The majority is supplied through processed foods and the consumption of meals prepared outside the home. In order to reduce salt consumption, the consumption of processed foods should be reduced and the consumption of unprocessed foods such as vegetables and fruits should be increased. It is advisable to season food with less salt, but with plenty of herbs and spices. It is easier to reduce your salt intake if you do so in small steps so that you can get used to the weaker salt taste.

Further information

www.nephie.de - The website of the self-help group Nephie e. V. offers those affected with nephrotic syndrome and family members information, appointments on the subject of nephrotic syndrome and contact persons.

Authors

Dr. André Lauber, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 13:28


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.