Clinical manifestations of nephrotic syndrome

The clinical manifestations of nephrotic syndrome may be influenced by some internal and external factors, but almost all clinical manifestations of nephrotic syndrome will have the following symptoms.

1. Edema

Patients with different types of nephrotic syndrome, such as nephritis nephrotic syndrome, primary nephrotic syndrome, and so on, can experience varying degrees of edema in clinical practice. Edema is most evident in the face, lower limbs, and scrotum. Patients with nephrotic syndrome have body edema that can last for weeks or months, or it may disappear when accompanied by the disease. When a patient experiences infection (especially streptococcal infection), swelling often leads to recurrence or exacerbation, and may even lead to azotemia.

2. Proteinuria.

The appearance of a large number of proteinuria symptoms is one of the reliable indicators for diagnosing nephrotic syndrome.

3. Hyperlipidemia.

Abnormal lipid metabolism in patients with nephrotic syndrome leads to an increase in almost all types of lipoprotein components in their plasma, with a significant increase in total cholesterol and low-density lipoprotein cholesterol, as well as an increase in triglycerides and extremely low density lipoprotein cholesterol.

4. Hypoalbuminemia.

Patients with nephrotic syndrome lose a large amount of albumin in their bodies, and their serum albumin levels are often below 30g/L, making it easy to develop hypoproteinemia.

So, how long can one live with nephrotic syndrome?

The clinical manifestations of nephrotic syndrome are different for each patient, and patients need to improve their treatment plans based on their own clinical manifestations. Of course, patients still need to communicate with their own doctors to determine the appropriate plan for their treatment. Here is an introduction to the treatment methods for nephrotic syndrome, hoping to be helpful to patients.

The clinical manifestations of early nephrotic syndrome may manifest as the following symptoms

1. Tired. Nephrotic patients are particularly prone to feeling tired due to their inability to remove waste from their bodies, and of course, they can also experience fatigue and asthma due to anemia. Clinical experience has shown that 70% of people with kidney disease are caused by overwork and physical exhaustion, so no matter what you do, you should not make your body too tired. However, fatigue is also the most easily overlooked and confused symptom of kidney disease, which requires special attention from everyone.

2. Edema. Swelling on the face and feet is often the main symptom of kidney disease, especially in children. Acute glomerulonephritis and nephrotic syndrome often manifest as swelling in the early stages. But sometimes swelling doesn't necessarily mean kidney disease, it's best to seek a doctor's examination if this happens!

3. Headache. The main reason for headaches in patients with kidney disease is that the kidneys cannot discharge excess waste from the body, and it can also be caused by increased blood pressure.

4. Abnormal urination. The abnormal urination mentioned here may be frequent urination, hematuria, foam in urine, etc. Among them, the presence of foam in urine may be caused by proteinuria, while the main symptom of kidney disease is the presence of trace blood in urine.

5. Low back pain. The kidneys are located on both sides of our waist, and inflammation or stones can cause pain in the kidney area. At this time, it is necessary to immediately seek medical examination for the cause.

In the late stage of nephrotic syndrome, the clinical manifestations of nephrotic syndrome will manifest as the following symptoms

1. Infection:

Protein malnutrition, high edema, and local poor blood circulation, combined with the use of glucocorticoids or immunosuppressants for treatment, make kidney disease patients highly susceptible to various infections.

Common infections include respiratory tract, skin, urinary tract, and abdominal cavity, with upper respiratory tract infections being the most common, accounting for over 50%. Viral infections are common in respiratory tract infections, but they are often accompanied by bacterial infections or both. Tuberculosis infection should also be taken seriously. In addition, hospital infections in children with kidney disease cannot be ignored, with respiratory and urinary tract infections being the most common, and the pathogenic bacteria are mainly conditional pathogens.

2. Electrolyte disorders and low blood volume:

Common electrolyte disorders include hyponatremia, hypokalemia, and hypocalcemia. Inappropriate long-term salt prohibition or long-term consumption of sodium free salt substitutes, excessive use of diuretics, as well as factors such as infection, vomiting, and diarrhea, can lead to hyponatremia. Under the above inducing factors, anorexia, fatigue, drowsiness, decreased blood pressure, and even shock, convulsions, etc. may occur. If a large amount of diuretics or hormones are used, causing loss of appetite and neglecting timely potassium supplementation can lead to hypokalemia. When there is a large amount of proteinuria, calcium often binds to protein and is lost with urine. In addition, long-term use of hormones and decreased levels of vitamin D during kidney disease can lead to poor intestinal calcium absorption, reduced sensitivity of bones to parathyroid hormones, and even hypocalcemia and hypocalcemic seizures. In addition, due to hypoproteinemia, plasma colloid osmotic pressure decreases and there is significant edema, and hypovolemia often occurs, especially when various inducements cause hyponatremia, hypovolemic shock is prone to occur.

3. Thrombosis:

NS hypercoagulable state is easy to cause various arterial and venous thrombosis, which is common in renal vein thrombosis, manifested as sudden low back pain, hematuria or hematuria aggravation, oliguria and even renal failure. However, subclinical types of vascular thrombosis in different parts of the body are more common in clinical practice. In addition to the formation of renal vein thrombosis, there may be: ① The degree of edema of both limbs is fixed differently, which does not change with the change of the position of the medical education network. Thrombosis of deep veins of lower limbs is common; ② Sudden purple spots on the skin and rapid expansion; ③ Scrotal edema appears purple; ④ Intractable ascites; ⑤ When the symptoms and signs such as lower limb pain accompanied by the disappearance of the pulse of the dorsalis pedis artery, the thrombosis of the lower limb artery should be considered. If not treated with timely thrombolysis, it can lead to limb necrosis and require amputation; ⑥ When coughing, hemoptysis, or breathing difficulties of unknown causes without positive lung signs, one should be vigilant for pulmonary embolism, half of which may not have clinical symptoms; ⑦ Sudden neurological symptoms such as hemiplegia, facial paralysis, aphasia or change of mind should be considered when excluding hypertensive encephalopathy and intracranial infectious diseases. The clinical symptoms of patients with slow thrombosis are often not obvious.

The main cause of thrombosis is the presence of hypercoagulable state during NS, due to: ① increased synthesis of coagulation factors in the liver, formation of high fibrinogenemia, and an increase in factors II, V, VII, VIII, and X; ② The concentration of anticoagulants in plasma decreases, especially due to excessive loss of antithrombin III in urine; ③ Increased platelet count, increased adhesion and aggregation rate; ④ When hyperlipidemia occurs, blood flow is slow and blood viscosity increases; ⑤ Infection or vascular wall damage activates the endogenous coagulation system; ⑥ Excessive use of powerful diuretics reduces blood volume and concentrates blood; ⑦ Long term high-dose hormone application can promote hypercoagulable state, etc.

4. Acute renal failure:

5% of patients with minimal change nephropathy may develop acute renal failure. This type of child has no decrease in blood volume or acute glomerular necrosis, which may be related to interstitial edema, increased pressure in the proximal convoluted tubules and Bowman's capsule, and even decreased glomerular net filtration pressure. One of the reasons for renal obstruction is also caused by protein tube type. This type of renal failure can occur in the early stage of kidney disease or at any stage of the course of the disease, but it is often seen when there is obvious fluid retention. The children show long-term oliguria (1 week to 1 month), BUN and creatinine increase, and the specific gravity of urine decreases. A large number of long or double tube types can be seen in the urine.

When acute renal failure occurs in NS clinical practice, the following reasons should be considered: ① acute interstitial nephritis, which can be caused by the use of synthetic penicillin, furosemide, and non steroidal anti-inflammatory drugs; ② Severe renal interstitial edema or a large amount of protein tube type leading to renal obstruction; ③ On the basis of the original pathology, a large number of crescents are formed; ④ Prerenal azotemia or complications caused by decreased blood volume. Renal vein thrombosis.

5. Renal tubule dysfunction: In NS, in addition to the damage of renal tubule function caused by the underlying disease of the original glomerulus, the reabsorption of a large amount of urine protein can lead to damage of renal tubule function, mainly the proximal convoluted tubule function. Clinically, renal diabetes or aminoaciduria can be seen, and in severe cases, it can present as Faneoni syndrome. This type of child has poor response to glucocorticoid treatment and poor long-term prognosis.

The clinical manifestations of nephrotic syndrome vary depending on the severity of the condition, but regardless of which stage of nephrotic syndrome, there will be a characteristic of three highs and one low.