Causes of edema in nephrotic syndrome

Written by Zhou Qi
Nephrology
Updated on September 04, 2024
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Edema is a diagnostic criterion for nephrotic syndrome, as well as a major clinical symptom and characteristic of the syndrome. There are several reasons why patients develop edema.

First, a large amount of protein leaks out from the kidneys, causing a decrease in the concentration of plasma albumin and a decrease in the colloid osmotic pressure in the plasma, which makes it easy for water to move from inside the blood vessels to outside, causing edema.

Second, patients with nephrotic syndrome have increased vascular permeability, which also makes it easy for water to enter the interstitial tissues. Among patients with nephrotic syndrome, some are prone to acute renal failure, which further decreases the kidney's ability to excrete water, and these factors together lead to the common occurrence of edema in patients.

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Written by Wu Ji
Nephrology
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What is nephrotic syndrome?

Nephrotic syndrome is a common manifestation of glomerular disease, caused by a variety of etiologies, with large differences in treatment response and prognosis. The pathological causes of nephrotic syndrome are diverse, with the most common types being minimal change disease, focal segmental glomerulosclerosis, mesangial proliferative nephritis, membranous nephropathy, and membranoproliferative glomerulonephritis. Nephrotic syndrome can be classified into primary and secondary types based on its cause. The diagnosis of primary nephrotic syndrome mainly depends on the exclusion of secondary nephrotic syndrome. Common causes of secondary nephrotic syndrome include diabetic nephropathy, lupus nephritis, renal amyloidosis, drug-induced nephropathy, and renal tumors.

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Written by Wu Ji
Nephrology
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Criteria for the diagnosis of nephrotic syndrome

The diagnostic criteria for nephrotic syndrome include massive proteinuria, with urinary protein greater than 3.5 grams/day, hypoalbuminemia, with plasma albumin less than 30 grams/liter, severe edema, and hyperlipidemia, which includes significant increases in plasma cholesterol and triglycerides. The first two criteria are essential for the diagnosis of nephrotic syndrome, while the latter two are secondary. Clinically, if the two necessary criteria are met, the diagnosis of nephrotic syndrome is established. Patients with nephrotic syndrome should undergo a renal biopsy to determine the pathological type and guide clinical treatment.

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Written by Zhu Wei
Nephrology
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What should not be eaten with nephrotic syndrome?

Patients with nephrotic syndrome, if the patient has obvious edema, should limit salt intake to between two to three grams per day. It is suggested to consume foods rich in polyunsaturated fatty acids, such as vegetable oils, as well as foods rich in soluble fiber, such as oats. They should also receive a normal amount of 0.8 to 1 gram of high-quality protein per kilogram of body weight per day, mainly from egg whites, milk, lean meat, and fish. Calorie intake should be sufficient, and patients with nephrotic syndrome should eat less salty and pickled foods and consume less animal fat.

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Written by Zhang Hui
Nephrology
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What tests are conducted for nephrotic syndrome?

Patients with nephrotic syndrome need to complete routine urine tests, 24-hour urine protein quantification, liver and kidney function tests, routine blood tests, electrolyte panels, blood glucose tests, and lipid profiles. Additionally, it is important to determine the cause of nephrotic syndrome, excluding the possibility of nephrotic syndrome caused by immune system diseases, including tumors, vasculitis, lupus, and other diseases. These tests include rheumatoid immune panels, antinuclear antibody spectrum, anti-GBM antibodies, ANCA panel, and immunoglobulins. Moreover, these patients should undergo kidney ultrasound, tumor marker tests, and thyroid function tests.

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Written by Zhou Qi
Nephrology
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Can nephrotic syndrome be clinically cured?

Nephrotic syndrome, a disease that clinically cannot be completely cured, is a chronic illness with no concept of cure. However, with appropriate treatment plans, many patients can achieve effective relief. There are two criteria for judging treatment effectiveness: first, the patient's 24-hour urinary protein quantification is controlled below 0.5 grams, and even can be controlled below 0.3 grams. Second, the patient's 24-hour urinary protein quantification is reduced by more than half compared to the baseline value. Both scenarios indicate effective treatment, but achieving a complete cure is difficult.