The Treatment and Prognosis of Nephrotic Syndrome in the Elderly

I. The treatment of Nephrotic Syndrome in the elderly There is no obvious difference between the treatment methods of Nephrotic Syndrome in the elderly and in the young. The curative effect and the prognosis of Nephrotic Syndrome in the elderly relate to the pathological types. Minimal Change Nephrotic Syndrome in the elderly responds well to glucocorticoid and cytotoxic drugs, and most of the elderly with Nephrotic Syndrome can get good curative effects. However, for cases of Membranous Nephropathy and Membranous Proliferative Glomerulonephritis, the curative effects are reported various. It is reported that by the treatment of the combination of prednisone and cytotoxic drugs, Nephrotic Syndrome in the elderly can be remitted completely or partially, and Kidney Failure can also be prevented. When using hormones and cytotoxic drugs in the elderly, the occurrence of the side effects should be paid attention to, such as hypertension, liver and kidney dysfunctions, secondary infections, water and electrolyte imbalance, induced tumor diseases, etc. If Nephrotic Syndrome in the elderly can not be controlled well, it can develop into Glomerulosclerosis. By immunofluorescence, IgM and C3 deposits can be seen. Such kind pathological manifestation can also be seen in the end stage of other glomerular diseases, or secondary kidney diseases such as Diabetic Nephropathy and Hypertensive Nephropathy. II. The prognosis and prevention of Nephrotic Syndrome in the elderly The prognosis of Nephrotic Syndrome in the elderly differs from person to person. Besides the pathological type, the main factor which can affect the prognosis, clinical factors such as large amounts of proteinuria, hypertension and hyperlipidemia can also promote the glomerular sclerosis. If the aforementioned factors can not be controlled in a long term, then the prognosis will be poor. In preventing Nephrotic Syndrome in the elderly, patients should pay attention to the following points: 1. Primary prevention Doing some appropriate exercises so as to increase the body immunity. Avoiding catching a cold or over fatigue Avoiding taking nephrotoxic drugs

 Doing periodic check 2. Secondary prevention Taking medicines timely when catching a cold. Kinds of infections on the whole body should be treated in time. And when using medicines, drug allergy should be pay attention to, so as to avoid inducing or aggravating Nephrotic Syndrome in the elderly. If proteinuria occurs, the causes should be found out, and it should be treated timely. When the condition is stable, periodic check is necessary. For patients with kidney function decline, the nephrotoxic drugs should be avoided. 3. Tertiary prevention It refers to the treatments which aim at treating the primary diseases so as to reduce the damages to the kidney

The Complications of Nephrotic Syndrome

The Complications of Nephrotic Syndrome If not controlled well, patients with Nephrotic Syndrome may suffer from the following complications. The first complication is that patients with Nephrotic Syndrome may get infected. A large amount of immune globulin is lost in urine, the protein in serum decreases, which influence the form of antibody. The application of cortin and cytotoxic drugs can also make the resistance of the body declines and people may get infected easily such as skin infection, primary peritonitis, and so on. The second complication of Nephrotic Syndrome is coronary heart disease. Patients with Nephrotic Syndrome often have hyperlipemia and are often under hypercoagulable state.

The third complication of Nephrotic Syndrome is thrombsis. Especially for those with membrane kidney disease, the morbidity of thrombsis is 25% to 40%. The reason why thrombsis comes into being is edema, little movement, and so on. The fourth complication of Nephrotic Syndrome is acute renal failure. Patients with Nephrotic Syndrome have a large amount of proteinuria, hypoproteinemia and hyperlipemia. They are often under Hypovolemia and Hypercoagulation State. The application of antihypertensive agent and diuretic both can decline the renal blood perfusion immediately and further make the glomerular filtration rate decrease, which leads to acute renal failure. In addition, patients with Nephrotic Syndrome have edema in renal interstitial, which can also lead to acute renal failure. The last complication of Nephrotic Syndrome is metabolic disturbance and electrolyte disturbance. Recurrent use of diuretic or long time incorrect forbidding Salt can lead to secondary hyponatremia. The application of cortin and a large amount of diuretic lead to a large amount of urine discharging. If potassium can not be supplied in time, hypokalemia will take place.

Nephrotic Syndrome
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Prevention
Avoiding situations or controlling the other diseases that can contribute to kidney disease can sometimes prevent nephrotic syndrome. The earlier a person changes the things that damage the kidneys, the better. You can help prevent kidney damage by:

Keeping your blood pressure at less than 125/75 mm Hg with medicine, diet, and exercise. For more information, see the topic High Blood Pressure. Keeping strict control over your blood glucose level if you have diabetes. For more information, see the topic Type 1 Diabetes or Type 2 Diabetes. Maintaining healthy levels of fats (lipids), such as cholesterol and triglycerides. For more information, see the topic High Cholesterol. Not smoking or using other tobacco products. For more information, see the topic Quitting Smoking.

Nephritic Syndrome

Prevention
Though the prevention of Nephritic Syndrome is not actually possible because of subtle initial signs and symptoms, but visiting a doctor immediately after the appearance of some suspicious signs like blood in urine, can be really helpful in preventing the occurrence of complications. Through immediate diagnosis and treatment, the kidney can function become normal within few weeks to months.

The causative agents like Streptococcal infection should be treated completely. Any recurrence should be monitored as prolonged infection can lead to kidney problem. The blood pressure of the patient should be kept under control as it will help to maintain functional integrity of the kidney

Complications

Chronic Nephritic Syndrome Pulmonary Edema (it is excessive build up of the fluid in the lung sacs causing shortness of breath) Congestive Cardiac Failure (inability of the heart to pump enough blood to the whole body) Nephrotic Syndrome (combination of the signs including protein in the urine, decrease in albumin in the blood and swelling due to the collection of fluids in the body) Complete Kidney Failure

Prognosis

The outcome of the syndrome depends upon the age, cause and start of the treatment. If the patient is younger, the cause is known and the treatment is prompt, it can show very good prognosis.

If the patient is old and the underlying cause is not known and diagnosis is delayed, then the condition may not be resolved and might lead to complication like Kidney Failure

Medicinal Treatment

Diuretics like Acetazolamide may be prescribed to help the kidneys excrete excess sodium and water. Calcium Channel Blockers: High blood pressure needs to be treated using antihypertensive drugs like calcium channel blockers e.g. Virapamil, Nefidipine ACE inhibitors like Enalapril may also help to control the blood pressure Corticosteroids like Prednisolone, Hydrocortisone can be given initially for a week Immunosuppressants like Cyclophosphamide can be given, if underlying cause is autoimmune in nature. If syndrome has occurred after bacterial infection, antibiotics like Penicillin can be given