Nephrotic syndrome and treatment of common complications

( 1 ) Infection : Infection is one of the most common complication of nephrotic syndrome , before the advent of effective antibiotics , infection is a major cause of death in patients with nephrotic syndrome , especially in infants and elderly patients more likely to be complicated by infection and died. Generally believed that patients with nephrotic syndrome complicated by infection because of malnutrition , low levels of serum IgG , the lack of factor B and the use of immunosuppressive agents and so on. However, recent studies have shown that immunosuppressants. Nephrotic syndrome makes use of shorter duration , thus reducing the chance of infection. Nephrotic syndrome risk factors for infection mainly serum IgG levels decreased ( albumin levels and 24-hour urinary protein excretion closely related ) and creatinine levels rise. Common bacterial infections : respiratory tract infections, skin infections , peritonitis, sepsis and necrotizing hip abscess .
Common viral infections include:
Chickenpox , shingles, measles than normal weight . Therefore , nephrotic syndrome patients in their daily lives as much as possible to avoid contact with the source of infection , remission can be injected high serum globulin and pneumococcal vaccination , once infection occurs , should immediately be given a strong anti-infectives .
( 2 ) hyperlipidemia : nephrotic syndrome is characterized by abnormal lipid metabolism of plasma lipoproteins ingredients have increased , generally elevated cholesterol appear first , followed by just as phospholipids and triglycerides. In addition to the number of changes, all kinds of lipoproteins , cholesterol / phospholipid and cholesterol / triglyceride values ​​were elevated . HDL may be elevated , normal or reduced . Lipid abnormalities commonly associated with proteinuria and ( or ) related to the degree of hypoalbuminemia . Comprehensive Kidney hyperlipidemia patients should pay attention to diet and avoid eating cholesterol-rich foods, eat more foods rich in unsaturated fatty acids , smoking cessation and appropriate exercise. When using lipid-lowering drugs to note that due to the low albumin make free drug concentration increases , the dose should be reduced in order to prevent the occurrence of side effects , while avoiding the use of diuretics can make elevated blood lipids .
( 3 ) hypovolemia and acute renal failure : blood volume can be increased in patients with nephrotic syndrome , normal or reduced, the situation is not necessarily correlated with the degree of changes in edema . Blood volume and more patients , often with diuretics may improve symptoms. , While patients with hypovolemia , after using diuretics, blood volume can be further reduced , resulting in cardiovascular instability , and even lead to acute renal failure. Now that the nephrotic syndrome due to acute renal failure among renal ischemia and renal interstitial edema caused by two factors working together . Effective hypovolemia lead to insufficient blood flow to the kidney ; tube deposition cause renal tubular obstruction , leading to Bowman capsule hydrostatic pressure, causing ischemia, can make the glomerular filtration rate . Fully concurrent renal acute renal failure, acute renal failure, according to treatment, after appropriate treatment , renal function can often be improved. There are some cases develop chronic renal failure, need lifelong renal replacement therapy.
( 4 ) renal tubular dysfunction : Patients with heavy proteinuria , particularly pathology tubular atrophy and interstitial fibrosis , could occur proximal tubule dysfunction , there may be clinical diabetes , high urinary phosphate , amino acids in urine , loss loss of potassium and bicarbonate (Fanconi syndrome ) . Proteinuria in patients with severe renal tubular excretion of creatinine increase , would lead to an overestimation of patients with creatinine clearance , which is in glomerular function should be evaluated for consideration to . Abnormalities, except no special treatment beyond symptomatic for renal tubular function , mainly because the treatment of the primary disease .
( 5 ) immune abnormalities : nephrotic syndrome some humoral and cell-mediated immune dysfunction , which is the primary cause of nephrotic syndrome pathogenesis , but also with low albumin , IgG and factor B decreased immune modulators iDL increases, low transferrin, albumin , zinc , increased prostaglandin synthesis and the use of immunosuppressive drugs ( especially cyclophosphamide ) and other factors. Treatment mainly for the treatment of primary disease , remission can use some enhanced active and passive immunization agents and traditional Chinese medicine.

( 6 ) thrombosis and embolism : Visible renal vein thrombosis, pulmonary vein , or pulmonary situ thrombosis , pulmonary embolism , peripheral venous or arterial thrombosis. The reason may lie in a hypercoagulable state when renal comprehensive , antithrombin Ⅲ absence or reduced fibrinolysis , platelet aggregation enhancement, increased procoagulant substances , hyperlipidemia , slow blood flow , endothelial cell damage and hormone therapy factors can have a significant impact on this . Rational use of anticoagulants in the treatment of nephrotic syndrome , can reduce this complication .