Kidney Disease Popular Science | What terrible complications does nephrotic syndrome bring?

Xiao Wu, who was only 28 years old, went to the local hospital for treatment because of facial edema for 2 weeks after catching a cold. The laboratory test results were consistent with the diagnosis of "nephrotic syndrome". At the same time, Xiao Wu also had symptoms such as coughing, sputum, and fever, and chest CT indicated the presence of lung infection. Therefore, antibiotics and diuretics were given for treatment. After treatment, Xiao Wu's edema was reduced and his body temperature returned to normal, but then he developed blood in his sputum, hemoptysis, progressive shortness of breath, chest tightness, and dyspnea. Spiral CT pulmonary angiography confirmed multiple pulmonary artery embolism. He was immediately admitted to the emergency room and the intensive care unit. After active anticoagulation and hormone treatment, his shortness of breath and dyspnea were significantly reduced, and his condition gradually stabilized. Xiao Wu has a question, I only have kidney disease, but why did it almost cost me my life? Let's take a look at the terrible complications of nephrotic syndrome!

An infection that cannot be underestimated

Infection is the most common complication in patients with nephrotic syndrome and the main cause of relapse and poor therapeutic effect. In severe cases, it can even cause death.

Why are patients with nephrotic syndrome prone to infection? There are mainly the following reasons.

1. Hypoproteinemia and malnutrition lead to decreased resistance of patients.

2. Certain immunoglobulins are lost in the urine, causing immune dysfunction.

3. Treatment with glucocorticoids and some immunosuppressive drugs may lead to decreased immunity.

The most common is respiratory tract infection, which manifests as cough, sputum, and even difficulty breathing. The second most common is urinary tract and skin soft tissue infection, which manifests as frequent urination, urgent urination, painful urination, and local skin redness, swelling, heat, and pain.

Therefore, patients with nephrotic syndrome must pay attention: when signs of infection appear, such as coughing, sputum, frequent urination, urgency, or redness, swelling, heat and pain in a certain part of the skin, do not be careless. Please go to a regular hospital for diagnosis and treatment as soon as possible to avoid delaying the disease.

Thrombosis and embolism

Patients with nephrotic syndrome are prone to thrombosis, especially those with membranous nephropathy, with an incidence of 25% to 40%. Thrombosis and embolic complications are important factors affecting the treatment effect and prognosis of nephrotic syndrome.

In nephrotic syndrome, edema, decreased activity, and hyperlipidemia causing venous congestion, blood concentration increasing viscosity, excessive levels of fibrinogen and some coagulation factors, and hypercoagulable state of blood caused by adrenal cortex hormones are all causes of thrombosis.

Where are the sites where blood clots form?

1. Renal vein thrombosis

This is the most common site. Thrombosis forms slowly in 3/4 of patients and may not cause clinical symptoms. If it is acute renal vein trunk thrombosis, the patient may suddenly experience side lumbar pain, hematuria, or worsening of existing proteinuria and hematuria. B-ultrasound shows that the size of the kidney on the affected side has increased significantly.

2. Pulmonary embolism

If the patient suddenly feels shortness of breath, chest pain, cough, hemoptysis, blood in sputum, or difficulty breathing, it is possible that pulmonary embolism has occurred and the patient should go to the hospital immediately. If the main trunk of the pulmonary artery is embolic or the embolic area is large, there is a possibility of sudden death.

3. Lower limb venous thrombosis

If the patient finds that the thickness of his or her lower limbs is different, he or she needs to go to the hospital for B-ultrasound and other examinations to further determine whether there is a possibility of lower limb venous thrombosis.

In addition, embolism may also occur in the cerebral blood vessels and coronary arteries of the heart.

Acute kidney injury

What are the causes of nephrotic syndrome complicated by acute kidney injury?

1. Hypovolemia and hypercoagulable state caused by nephrotic syndrome.

2. Vomiting, diarrhea, use of antihypertensive drugs and large amounts of diuretics may cause a sudden decrease in renal blood perfusion.

3. Edema occurs in the renal interstitium inside the kidney, compressing the renal tubules, and the concentrated protein forms casts that further block the renal tubules.

Protein and fat metabolism disorders

Why do patients with nephrotic syndrome have disorders in protein and fat metabolism? What are its hazards?

1. Long-term hypoproteinemia can lead to malnutrition, decreased resistance, and susceptibility to infection. It may affect growth and development in childhood.

2. The loss of metal-bound proteins can lead to a deficiency of trace elements (iron, copper, zinc, etc.), which can also affect the growth and development of children.

3. Insufficient protein binding to endocrine hormones can induce endocrine disorders.

4. Drug binding proteins can affect the metabolism of certain drugs and affect the efficacy of the drugs.

5. Hyperlipidemia increases blood viscosity and promotes the occurrence of thrombosis and cardiovascular and cerebrovascular diseases.

Therefore, patients with nephrotic syndrome must seek medical treatment promptly and receive active treatment to prevent various complications from becoming more serious.