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nephrotic syndrome[nə′fräd·ik ′sin‚drōm]
the modern designation for a group of kidney diseases whose symptoms include considerable proteinuria (the loss of more than 5 g of protein per day through the urine), disturbances in the protein-fat metabolism, and—in most cases—edema. The term “nephrotic syndrome” replaced the obsolete term “nephrosis” in the 1950’s and was formally introduced in 1968 into the nomenclature of diseases.
The nephrotic syndrome is usually a consequence of nephritis, amyloidosis, nephropathy during pregnancy, pyelonephritis, tumors, lesions of the kidneys as a result of collagenosis, myeloma, diabetes mellitus, tuberculosis, syphilis, or malaria. In certain instances, especially in children, it is impossible to find the cause of the nephrotic syndrome. In these cases, the syndrome is called a primary, or idiopathic, nephrotic syndrome. The most widespread of the theories explaining the pathogenesis of the nephrotic syndrome is the immunological theory: antibodies directed against the kidneys are formed, eliciting an increase in the permeability of the glomerular filter of the kidneys. Such an increase in permeability leads to proteinuria.
The most important clinical manifestation of the nephrotic syndrome is edema, which occurs first on the face and then spreads to the entire subcutaneous tissue. Because of the loss of protein through the urine and because of metabolic disturbances, the concentration of protein in the blood decreases. This decrease is greatest in the finely dispersed fractions of the blood. Other symptoms include muscular weakness and a lowered resistance to infection. The fat content of the blood increases sharply.
Treatment of the nephrotic syndrome involves bed rest, a low-salt and low-water diet with an adequate protein content, anabolic hormones, diuretics, corticosteroids, 4-aminoquino-lines, immunosuppressants, and indole derivatives. Treatment at a climatic resort, such as Bairam-Ali, is recommended when the syndrome is not aggravated by renal insufficiency and persistent hypertension. Lola in the Kalmyk ASSR and the Southern Crimean Shore are both recommended for the more moderate cases of the nephrotic syndrome.
REFERENCEOsnovy nefrologii, vol. 1. Edited by E. M. Tareev. Moscow, 1972.
N. R. PALEEV