Urology P a g e | 1

 Nephrotic syndrome is a kidney disorder that causes a person’s body to excrete too much protein in their urine.  Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in the kidneys that filter waste and excess water from the blood. When healthy, these vessels keep blood protein from seeping into the urine and out of the body. When damaged, they don't perform this function effectively, and protein can leak out of the blood and lead to swelling all over the body (edema).

A study from New Zealand found the incidence of nephrotic syndrome to be almost 20 cases per million children under age 15 years. In specific populations, such as those of Finnish or Mennonite origin, congenital nephrotic syndrome may occur in 1 in 10,000 or 1 in 500 births, respectively. According to the International Study of Kidney Diseases in Childhood (ISKDC), 84.5% of all children with primary nephrotic syndrome have minimal-change nephrotic syndrome (MCNS), 9.5% have focal segmental glomerulosclerosis (FSGS), 2.5% have mesangial proliferation, and 3.5% have membranous nephropathy or another cause of the disease. Increasing trends of FSGS incidence are being reported, but MCNS remains the most important cause of chronic renal disease in children.

Signs and symptoms of nephrotic syndrome include:
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Swelling (edema), particularly around the eyes and in the ankles and feet Foam in the toilet water, which may be caused by excess protein in the urine Weight gain due to excess fluid retention The glomeruli filter blood as it passes through the kidneys, separating things that body needs from those it doesn't. Healthy glomeruli keep blood protein (mainly albumin) — which is needed to maintain the right amount of fluid in the body — from seeping into the urine. When damaged, glomeruli allow too much blood protein to leave the body, leading to nephrotic syndrome.

>Nephrotic syndrome is usually caused by damage to the clusters of tiny blood vessels (glomeruli) of the kidneys.

Many possible causes Many diseases and conditions can cause glomerular damage and lead to nephrotic syndrome, including:

Minimal change disease. The most common cause of nephrotic syndrome in children, this disorder results in abnormal kidney function, but when the kidney tissue is Intellectual property of BSN III-A, RLE Grp. Mariano Marcos State University College of Health Sciences

This kidney disorder is the result of thickening membranes within the glomeruli. but it's sometimes associated with other medical conditions. Complications Possible complications of nephrotic syndrome include:  Blood clots. the liver releases more cholesterol and triglycerides. minimal change disease and other kidney diseases. Focal segmental glomerulosclerosis. This disorder occurs when substances called amyloid proteins accumulate in the organs. such as diabetes. amyloidosis. hepatitis C and malaria. Some forms of heart failure. lupus. The exact cause of the thickening isn't known. Renal vein thrombosis. When the level of the protein albumin in the blood falls. The cause of the abnormal function typically can't be determined. Amyloidosis.  Certain infections. Systemic lupus erythematosus. such as constrictive pericarditis and severe right heart failure. Membranous nephropathy. Diabetic kidney disease. Certain diseases and conditions increase your risk of developing nephrotic syndrome. RLE Grp. At the same time. such as hepatitis B.Urology P a g e | 2 examined under a microscope. Examples of infections that increase the risk of nephrotic syndrome include HIV. it appears normal or nearly normal. Intellectual property of BSN III-A. the liver makes more albumin.  Certain medications. which occurs when a blood clot blocks a vein connected to the kidney. malaria. this condition may result from another disease or a genetic defect or occur for no known reason. Mariano Marcos State University College of Health Sciences . Examples of medications that can cause nephrotic syndrome include nonsteroidal anti-inflammatory drugs and drugs used to fight infections. Amyloid buildup often affects the kidneys. Diabetes can lead to kidney damage (diabetic nephropathy) that affects the glomeruli. This chronic inflammatory disease can lead to serious kidney damage. The inability of the glomeruli to filter blood properly can lead to loss of blood proteins that help prevent clotting. Blood clot in a kidney vein. hepatitis B. Heart failure.        Risk factors Factors that can increase your risk of nephrotic syndrome include:  Medical conditions that can damage your kidneys. can cause nephrotic syndrome. This increases your risk of developing a blood clot (thrombus) in the veins. damaging their filtering system.  High blood cholesterol and elevated blood triglycerides. Characterized by scattered scarring of some of the glomeruli. can cause nephrotic syndrome. lupus and cancer.

People with nephrotic syndrome have an increased risk of infections. Medications may include:  Blood pressure medications.Urology P a g e | 3      Poor nutrition. a person may need emergency dialysis — an artificial means of removing extra fluids and waste from the blood — typically with an artificial kidney machine (dialyzer). captopril (Capoten) and enalapril (Vasotec). Infections. Loss of blood protein may cause an increase in blood cholesterol and blood triglycerides. a blood test may show low levels of the protein albumin (hypoalbuminemia) specifically and decreased levels of blood protein overall. Tests and diagnosis Tests and procedures used to diagnose nephrotic syndrome include:  Urine tests. Chronic kidney failure.  Removing a sample of kidney tissue for testing. If kidney function falls low enough. Intellectual property of BSN III-A. If a person have nephrotic syndrome. waste products may build up quickly in the blood. Treatments and drugs Treatment for nephrotic syndrome involves treating the underlying medical condition that's causing the nephrotic syndrome. This can lead to weight loss. During a kidney biopsy. Acute kidney failure. Another group of drugs that works in a similar way is called angiotensin II receptor blockers and includes losartan (Cozaar) and valsartan (Diovan). Damage to the glomeruli and the resulting buildup of wastes in the bloodstream (uremia) can raise blood pressure. Kidney tissue is collected and sent to a laboratory for testing. If the kidneys lose their ability to filter blood due to damage to the glomeruli. If this happens. Serum creatinine and blood urea also may be measured to assess the overall kidney function. The doctor may also recommend medications that may help control the signs and symptoms or treat complications of nephrotic syndrome. Drugs called angiotensin-converting enzyme inhibitors reduce blood pressure and also reduce the amount of protein released in urine. Loss of too much blood protein can result in malnutrition. a special needle is inserted through the skin and into your kidney. Mariano Marcos State University College of Health Sciences . High blood pressure.  Blood tests. Nephrotic syndrome may cause the kidneys to gradually lose their function over time. The person may be asked to collect urine samples over 24 hours for an accurate measure of the protein in the urine. but it may be masked by swelling. such as large amounts of protein. A urinalysis can reveal abnormalities in the urine. if someone have nephrotic syndrome. a person affected may require dialysis or a kidney transplant. Medications in this category include benazepril (Lotensin). the doctor may recommend a procedure called a kidney biopsy to remove a small sample of kidney tissue for testing. RLE Grp.

rosuvastatin (Crestor) and simvastatin (Zocor). Blood thinners. such as membranous nephropathy. Cholesterol-reducing medications. Antibiotics can help control infections caused by bacteria. Antibiotics. lovastatin (Altoprev. Medications called anticoagulants help decrease the blood's ability to clot and reduce the risk of developing blood clots. Medications called statins can help lower cholesterol levels. -THERE IS NO SPECIFIC TREATMENT FOR NEPHROTIC SYNDROME Diet Management       Dietary CHON of 1 g/kg/day depending on the GFR Adults require 35-45 kcal/kg/day Na restricted to 0.3-1 g/day to control edema Patients receiving diuretics should have adequate K intake Limiting dietary fat is a little help to reduce triglyceride level Low salt diet and fluid limited to 1L Intellectual property of BSN III-A. Mevacor). Statins include atorvastatin (Lipitor). Anticoagulants include heparin or warfarin (Coumadin). Mariano Marcos State University College of Health Sciences . RLE Grp. Diuretic medications include chlorothiazide. fluvastatin (Lescol). Immune-system-suppressing medications.Urology P a g e | 4      Water pills. pravastatin (Pravachol). Medications to control the immune system. furosemide (Lasix) or spironolactone (Aldactone). Water pills (diuretics) help control swelling by increasing your kidneys' fluid output. may decrease the inflammation that accompanies kidney disorders. such as corticosteroids. hydrochlorothiazide.

 A urinary calculus or stone consists of a nucleus of organic material around which urinary salts are deposited in concentric layers. In one common scenario. allowing minerals to crystallize and stick together.  A renal calculus is one which forms in the pelvis or calyces of the kidney. Mariano Marcos State University College of Health Sciences . below the ribs Pain that spreads to the lower abdomen and groin Pain on urination Pink. These layers are bound together by a matrix of organic matter. RLE Grp. At that point. hard deposits that form inside the kidneys.Urology P a g e | 5 URINARY CALCULI/KIDNEY STONES/ NEPHROLITIASIS/RENAL CALCULI  Kidney stones (renal lithiasis) are small.  Passing kidney stones can be painful. these signs and symptoms may occur:     Severe pain in the side and back. red or brown urine Intellectual property of BSN III-A. Symptoms A kidney stone may or may not cause signs and symptoms until it has moved into the ureter — the tube connecting the kidney and bladder.  A vesical calculus is one which forms in the bladder. Kidney stones are made of mineral and acid salts. Kidney stones have many causes. kidney stones form when the urine becomes concentrated.

Struvite stones form in response to an infection. smooth and. Dietary factors. arginine. taking on their shape and then being known as Staghorn calculus. Cystine calculus only occurs in the urinary tract of those with Cystinuria. is typically faceted. soft and crumble easily. rarely. ornithine and cystine. RLE Grp. In an alkaline urine. create the conditions in which susceptible people develop kidney stones. These stones are smooth. The liver also produces oxalate. being covered with sharp projections. composed of the latter only. Such stones are usually single and are extremely hard. Uric acid and urate calculus is hard. When this happens. At the same time. the urine may be short of substances that keep crystals from sticking together and becoming stones. high doses of vitamin D. oxalate and uric acid. the urine contains more crystal-forming substances. These projections cause the kidney to bleed and altered blood is precipitated on the stone. may assume a cast of the renal pelvis and calyces and only appear in acid urine. usually in the form of calcium oxalate. Struvite stones can grow quickly and become quite large. intestinal bypass surgery Oxalate calculus consists of calcium oxalate and is popularly known as the mulberry stone. often in combination. a genetic disorder affecting renal and intestinal handling of lysine. such as a urinary tract infection. Such stones are usually soft. A number of factors. single cause. Calcium stones may also occur in the form of calcium phosphate. High oxalate levels can be found in some fruits and vegetables. Mariano Marcos State University College of Health Sciences . multiple. such as calcium. than the available fluid can dilute. and several different metabolic disorders can increase the concentration of calcium or oxalate in urine. Types of kidney stones Most kidney stones contain crystals of more than one type.  Struvite stones.Urology P a g e | 6    Nausea and vomiting Persistent urge to urinate Fever and chills if an infection is present Causes Kidney stones often have no definite. This creates an environment in which kidney stones are more likely to form. as well as in nuts and chocolate. Kidney stones form when the components of urine — fluid and various minerals and acids — are out of balance. Most kidney stones are calcium stones. Intellectual property of BSN III-A. Phosphatic calculus consists of calcium phosphate but this may be combined with ammonium magnesium phosphate and. it grows rapidly and may fill the renal calyces. because it is uncommonly found singly. Types of kidney stones include:  Calcium stones.

Not drinking enough water each day can increase the risk of kidney stones. they are at increased risk of developing another. cystinuria. Diseases and conditions that may increase the risk of kidney stones include renal tubular acidosis.  Cystine stones. hyperparathyroidism and certain urinary tract infections.  Other stones. though   kidney stones may occur at any age. increased waist size and weight gain have been linked to an increased risk of kidney stones. high-sodium and high-sugar may increase the risk of some types of kidney stones. too. Other.    Digestive diseases and surgery. those who eat a high-protein diet and those with gout. RLE Grp. Certain diets. Men are more likely to develop kidney stones. And if he/she already had one or more kidney stones. Mariano Marcos State University College of Health Sciences . inflammatory bowel disease or chronic diarrhea can cause changes in the digestive process that affect the absorption of calcium and increase the levels of stone-forming substances in teh urine. Gastric bypass surgery. Being obese. These stones represent only a small percentage of kidney stones. Dehydration. People who live in warm climates and those who sweat a lot may need to drink more water than others. the person is more likely to develop stones. Being a man. Eating a diet that's high-protein. Risk factors Factors that increase a person’s risk of developing kidney stones include:  Family or personal history of kidney stones. Knowing the type of kidney stone helps to understand what might have caused the stone to form and may give clues as to what a person can do to reduce their risk of getting additional kidney stones. Uric acid stones can form in people who are dehydrated. They form in people with a hereditary disorder that causes the kidneys to excrete excessive amounts of certain amino acids (cystinuria). Intellectual property of BSN III-A. Kidney stones are most common in adults age 40 and older. Certain genetic factors and disorders of the blood-producing tissues also may predispose to uric acid stones.Urology P a g e | 7  Uric acid stones. High body mass index (BMI).  Being an adult. If someone in the family has kidney stones.  Other medical conditions. rarer types of kidney stones can occur.

depending on the type of stone and the cause. Imaging tests may include computerized tomography (CT) or. the doctor may recommend pain relievers such as ibuprofen (Advil.  Pain relievers. less commonly. Mariano Marcos State University College of Health Sciences . To relieve mild pain. Passing a small stone can cause some discomfort. You may be able to pass a small stone by:  Drinking water. such as:  Blood tests. X-ray. Person may be asked to urinate through a strainer designed to catch any stones that may pass. The doctor uses this information to determine what's causing kidney stones and to formulate a plan to prevent future kidney stones. Blood tests may reveal excess calcium or uric acid in the blood. Drinking as much as 2 to 3 quarts (1. may show that a person is excreting too many stone-forming minerals or too few stone-inhibiting substances. any stones can be collected for laboratory testing. Motrin. RLE Grp. Imaging tests may show kidney stones in the urinary tract.8 liters) a day may help flush out the urinary system. Treatment for small stones with minimal symptoms Most kidney stones won't require invasive treatment. he/she may undergo tests and procedures to diagnose the condition.  Treatment for larger stones and those that cause symptoms Kidney stones that can't be treated with conservative measures — either because they're too large to pass on their own or because they cause bleeding. Procedures include: Intellectual property of BSN III-A. Blood tests allow the doctor to check for other medical conditions and to monitor the health of the kidneys. Tests of urine.9 to 2.Urology P a g e | 8 Tests and diagnosis If the doctor suspects that a person have a kidney stone. Treatments and drugs Treatment for kidney stones varies. acetaminophen (Tylenol. others) or naproxen sodium (Aleve). others). That way.  Imaging tests. such as the 24-hour urine collection.  Analysis of passed stones. A laboratory analysis will reveal the makeup of kidney stones.  Urine tests. kidney damage or ongoing urinary tract infections — may require more invasive treatment.

just below the Adam's apple.  Using a scope to remove stones. When these glands produce too much parathyroid hormone. Some calcium stones are caused by overactive parathyroid glands. resulting in excessive excretion of calcium in the urine. bleeding around the kidney and other adjacent organs. bruising on the back or abdomen. The doctor maneuvers the ureteroscope to the stone. This is sometimes caused by a small benign tumor in one of the four parathyroid glands.  Surgery to remove very large stones in the kidney. so the person may be under sedation or light anesthesia to make him/her comfortable. A procedure called percutaneous nephrolithotomy involves surgically removing a kidney stone through a small incision in the back. Intellectual property of BSN III-A. To remove a stone in thr ureter or kidney. which are located on the four corners of the thyroid gland. This surgery may be recommended if extracorporeal shock wave lithotripsy has been unsuccessful or if the stone is very large. The specifics of the procedure may vary depending on the type of equipment the doctor uses. special tools can snare the stone or break it into pieces that will pass in the urine. Extracorporeal shock wave lithotripsy can cause blood in the urine. A surgeon can remove the tumor or the parathyroid glands. The procedure creates a loud noise and can cause moderate pain. Once the stone is located. the body's level of calcium can become too high. and discomfort as the stone fragments pass through the urinary tract. the doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through the urethra and bladder to the ureter.  Parathyroid gland surgery. A procedure called extracorporeal shock wave lithotripsy uses sound waves to create strong vibrations called shock waves that break the stones into tiny pieces that are then passed in the urine.Urology P a g e | 9  Using sound waves to break up stones. Mariano Marcos State University College of Health Sciences . RLE Grp.

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