Introduction
Nephrotic syndrome is primarily a paediatric disease. It affects children fifteen times more than adults. It’s a group of symptoms that can appear if the kidneys aren’t working right.
Normally, small blood vessels in the kidneys function as a filter, clearing out waste and extra water from blood. That waste and water ends up in the bladder and leaves the body in the form of urine. These vessels are part of “glomeruli,” the filtering part of kidney.
When they’re damaged, too much protein slips through the filters into the urine. The result is nephrotic syndrome.
Signs & symptoms
There are four main signs or symptoms make up nephrotic syndrome. They are:
- Too much protein in urine, or proteinuria.
- High fat and cholesterol levels in the blood. The medical term for it is “hyperlipidaemia.”
- Swelling of legs, feet and ankles, and sometimes hands and face. This is called oedema.
- Low levels of albumin in the blood or hypoalbuminemia.
Causes
It can be due to either a primary cause, that affects only kidneys or a secondary cause that is an issue with another part of the body that also affects the kidneys.
Some of the conditions that can damage your glomeruli include:
Minimal change disease, which is the main cause of nephrotic syndrome in children. Kidney tissue from people with this disease looks relatively normal under a microscope but stops the kidneys from working properly. Some potential causes of the disease include infections from viruses, allergic reactions, taking certain medications, and using non-steroidal anti-inflammatory drugs (NSAIDs)
Focal segmental glomerulosclerosis, or FSGS, is a disease that scars the glomeruli. It’s the most common primary cause of nephrotic syndrome in adults. FSGS can be caused by a virus, such as HIV, or medications.
Membranous nephropathy, in which the membranes of the glomeruli thicken. Causes may include cancer, malaria, hepatitis B, and lupus.
Diabetes, which is the most common secondary cause of nephrotic syndrome in adults. It can cause kidney damage, known as diabetic nephropathy
Lupus (systemic lupus erythematosus), a chronic disease of the immune system, can seriously damage the kidneys.
Amyloidosis, a build-up of substances called amyloid proteins in the blood, can damage the kidneys
Taking nonsteroidal anti-inflammatory drugs (NSAIDs) regularly.
Pathophysiology
The formation of oedema is prevented in healthy patients by a balance between forces favouring oedema (capillary hydrostatic pressure [Pcap]) and those opposing it (capillary oncotic pressure [πcap]). The slight tendency toward fluid accumulation is counterbalanced by the lymphatics in the interstitial space. In nephrotic patients, hypoalbuminemia results when the liver fails to synthesize the loss of albumin through urine. The hypoalbuminemia results lead to low capillary oncotic pressure (πcap), which leads to relatively unopposed capillary hydrostatic pressure (Pcap) and subsequent oedema formation. Relative intravascular volume reduction is due to oedema formation. The intravascular volume which triggers neurohumoral compensatory mechanisms including sympathetic nervous system (SNS), arginine vasopressin (AVP), and the renin angiotensin aldosterone system (RAAS), with the net causes being sodium and water retention by the kidney. In the background of nephrotic syndrome, aortic arch, left ventricle, mechanoreceptors in the carotid sinus, and afferent arterioles in the glomeruli detect reduced pressure distension. This produce (1) SNS outflow increases from the central nervous system, (2) RAAS activation, and (3) non-osmotic release of AVP from the hypothalamus. These three changes lead to peripheral vasoconstriction (increased SNS and angiotensin II), sodium retention (angiotensin II, aldosterone, and increased SNS), and water retention.As a result of these mechanisms, it is greatly accepted that patients with nephrotic syndrome have an excess of total body water and sodium.
A urine test, to measure how much protein the kidneys are filtering out.
A complete kidney function blood & urine examination
Ultrasound scan
Renal biopsy taking a tissue sample of kidney for study under a microscope.
Treatments
Treatment depends upon the cause of the disease. Aim of the treatment is to control blood pressure & cholesterol and to relieve oedema.
Medicines include:
- Blood-pressure medications called ACE inhibitors and ARBs
- Diuretics, to reduce swelling
- Cholesterol-lowering drugs
- Anticoagulants, to make blood clots less likely
- Corticosteroids
Cut down salt and fatty items in diet
Dialysis in severe conditions
Prognosis
The prognosis for nephrotic syndrome under treatment is generally good although this depends on the underlying cause, the age of the person and their response to treatment. It is usually good in children, because minimal change disease responds very well to steroids and does not cause chronic kidney failure.
Complications
Blood clots inside the body or circulatory system
High cholesterol and triglycerides
High blood pressure
Kidney failure
Pneumonia
Meningitis
Disease & Ayurveda
There is no direct correlation or description in Ayurveda for nephrotic syndrome. But while explaining disorders of the urinary system where urine output is less than normal, Kaphaja mootrakrucchra can be compared with nephrotic syndrome to an extent by their clinical features.
Nidana
Causative factors for the vitiation of Kapha
Acharya Kashyapa explains the nidaana & samprapti for children seprarately. Due to carrying the child over waist or shoulders for long time, aggravated doshas settle over vasti, vitiating the same to produce the disease.
Purvaaroopa
Not mentioned separately
Samprapti
Normally, mootravahasrotas works through continuous filtration and filling of vasti by minute and numerous tubules. This process includes Vrkka (Kidney)gavini(ureter), mootravaha dhamanis and siras & nadi (Renal vessels and nerves associated) Vasti(badder) and mootrapraseka (urethral opening). When the vitiated Kapha causes any obstruction in this system, the disease manifests.
Lakshana
Vasti-medhara gourava & sopha- Heaviness & oedema of Bladder and penis/area of urethral opening
Sapiccham mootram- Turbidity of urine
Savibandham mootram- Obstructed urination
Divisions
No divisions
Prognosis
Sadhyam
Chikithsa
Samana
Teekshna-ushna-katu bhojanam(pungent,hot and spicy diet)
Diet with Yava (Barley)
Ksharam (Alkaline diet and drinks)
Kaalaseyam-buttermilk
Dhatreephalarasa+ela
Madya+ela
Kantakariswarasa+honey
Sodhana
Vamanam
Swedanam
Commonly used medicines
Veerataradi kashayam
Kumaryasavam
Gokshuradi guggulu
Punarnavasavam
Rasasindhooram
Pravala Bhasma
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Low sodium intake
Omega 3 fatty acid intake
Gluten free diet
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from hot climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle. Be active.
Yoga
No hectic exercises or physical activities are recommended in severe cases of nephroic syndrome, especially children.
Regular stretching and cardio exercises are advised in mild cases. Also, specific yogacharya including naadisuddhi pranayama, & pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
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