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NEPHROTIC SYNDROME

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NEPHROTIC SYNDROME develops due to massive loss of protein in the urine (large proteinuria), due to damage to various parts of the nephron. In the vast majority of cases, this syndrome occurs with glomerulonephritis and renal amyloidosis.

The leading clinical sign of nephrotic syndrome is hypoproteinemic edema, reaching the degree of anasarca, with accumulation of fluid in the abdominal cavity (ascites), pleural cavity (hydrothorax) and pericardium (hydropericardium). With an increase in hydrothorax and hydropericardium of patients, shortness of breath , heart palpitations disturb. Weakness, dry mouth, thirst appear. Edema usually develops gradually as proteinuria builds up. In this case, nephrotic syndrome can occur at the onset of the disease, without recurring or rarely recurring in the future, which is prognostically more favorable compared with a continuously recurring course. The severity of the patient's condition can be aggravated by a number of characteristic complications, in particular vascular thrombosis, pneumonia, less often sepsis. A nephrotic crisis is possible, in which areas resembling erysipelas appear on the skin, there is a fever , abdominal pain, vomiting , and diarrhea. This is a dangerous complication, therefore, urgent hospitalization of the patient is required.

The diagnosis is based on the detection of hypoproteinemic edema, massive daily proteinuria (more than 3.5 g of protein is released in 1 day) and hypoproteinemia, as well as other metabolic disorders (hyperlipidemia, hypercholesterolemia, water-electrolyte disorders) with a relatively long period of good glomerular filtration, no arterial hypertension

Treatment is carried out in a hospital. It is determined primarily by the disease that led to the development of the syndrome. It is advisable to preserve the physiological content of protein in food and reduce the consumption of salt (during edema to 1-2 g per day). With large edema, diuretic therapy with thiazides, furosemide, potassium-sparing and osmotic diuretics is indicated.