Nephrotic syndrome and its Diagnosis
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Nephrotic syndrome is a group of symptoms caused by kidney disease. Examples include urine protein, low blood albumin levels, high blood lipids, and considerable edoema. Other symptoms include weight gain, tiredness, and frothy urine. Complications such as blood clots, infections, and high blood pressure are all possible. A variety of kidney illnesses, including focal segmental glomerulosclerosis, membranous nephropathy, and minimal change disease, are among the causes. It can also happen as a result of diabetes or lupus. The underlying process is usually injury to the kidney's glomeruli.
Urine tests and, in certain cases, a kidney biopsy are used to get a diagnosis. It is distinguished from nephritic syndrome by the absence of red blood cells in the urine. The treatment focuses on the underlying reason. Other initiatives include lowering blood pressure, cholesterol, and infection risk. A low salt diet and hydration restriction are frequently advised. Each year, around 5 per 100,000 persons are impacted. The most common underlying reason differs between children and adults. In addition to acquiring a full medical history, a battery of biochemical testing is necessary to arrive at an accurate diagnosis that confirms the presence of the condition. In addition, imaging of the kidneys (for anatomy and the existence of two kidneys) and/or a biopsy of the kidneys are occasionally performed. The first test will be a urinalysis to look for excessive amounts of protein, as a healthy person excretes a little quantity of protein in their urine. A 24-hour bedside urine total protein estimate will be performed as part of the test. Proteinuria (>3.5 g per 1.73 m2 every 24 hours) is detected in the urine sample. It is also checked for urine casts, which are more common in active nephritis. A complete metabolic panel (CMP) blood test will be performed next to look for hypoalbuminemia: albumin levels of 2.5 g/dL (normal=3.5-5 g/dL). Then, a Creatinine Clearance CCr test will be performed to assess kidney function, specifically the glomerular filtration capacity. Creatinine is formed as a byproduct of muscle breakdown; it is carried in the blood and removed in the urine. The concentration of organic molecules in both liquids is used to assess the glomeruli's ability to filter blood. Electrolytes and urea levels can be measured at the same time as creatinine (EUC test) to assess renal function. A lipid profile will also be performed since high cholesterol values (hypercholesterolemia), notably higher LDL with concomitantly elevated VLDL, are symptomatic of nephrotic syndrome.
A kidney biopsy is another more specific and invasive screening procedure. A examination of the anatomical pathology of a sample may then allow the kind of glomerulonephritis implicated to be identified. However, this operation is often reserved for adults because the majority of children have minor change illness with a 95% remission rate with corticosteroids. A biopsy is typically only recommended for children who are resistant to corticosteroids, as the majority have focal and segmental glomeruloesclerosis. If the reason is not evident, further tests such as auto-immune markers (ANA, ASOT, C3, cryoglobulins, serum electrophoresis), or an ultrasound of the whole abdomen are recommended.