Lipoid nephrosis - causes, symptoms and diagnosis, treatment Lipoid nephrosis Lipoid nephrosis is a rare disease. This is one of the forms of nephrotic syndrome, in which the kidneys are mainly of a dystrophic nature.
The cause is most often a general illness:
If the cause of dystrophic changes in the kidneys can not be identified, the disease is designated as a lipoid nephrosis. Its causes are sharp disorders of metabolism in the body, mainly fat and protein. As a result, the processes of cellular nutrition and the permeability of the walls of the capillaries of the renal glomeruli are violated.
Protein particles and lipoids, in large quantities contained in the primary urine of patients, penetrate through the wall of the tubules, causing strong dystrophic changes in the epithelial cells. Recently, a great influence on the development of this renal pathology of the autoimmune mechanism has been revealed.
Lipoid nephrosis develops gradually. Affected people usually do not experience any pain and discomfort. Complaints happen only on considerable edemas which constrain and disturb. In a patient with lipoid nephrosis, the kidneys increase, the mass of one reaches 250 g. The capsule is easily removed, the surface is usually smooth, pale gray. The cortical layer is considerably expanded and has a yellowish gray color. This kidney is called a large white kidney.
The main symptom of lipoid nephrosis is an increased protein content in the urine. Its amount can reach up to 20-50% or more, which leads to a strong decrease in protein content in the blood. This leads to the formation of large edema. But since the vascular system of the kidneys is not affected, blood pressure remains normal, red blood cells in the urine are absent, and the concentration ability of the kidneys is not disturbed. In addition to protein in the urine, leukocytes, renal epithelial cells and various cylinders are contained: epithelial, granular, hyaline, and sometimes waxy. The latter appear in the urine with severe chronic kidney disease.
Patients with lipoid nephrosis complain, in addition to severe swelling throughout the body, weakness, decreased ability to work, chilliness, loss of appetite, strong thirst.
Abundant swelling does not appear immediately. First, the amount of protein in the urine begins to exceed normal values. Then the face pales, there is a weak puffiness and a decrease in mimicry. Gradually, swelling accrues, covering the entire subcutaneous tissue. Deformation of the face and trunk begins. But especially swelling is very visible on the face: it becomes puffy, eyelids swell, eyes narrow and open in the mornings with difficulty.
Fluid, accumulating in internal organs, in the abdominal and pleural cavities, sometimes in the pericardium, supports swelling for months and even years. They become very soft, mobile, and when pressing a finger on this place there is a rapidly disappearing deep pit. The skin in the places of edema is stretched, becomes shiny and can burst with the allocation of liquid milk color.
In edematous fluid, there are few proteins and many salts, in particular chlorides, and the number of lipoproteins is increased. The volume of edematous fluid in some cases reaches 20 liters or more. Skin breakthroughs are very dangerous, since infection, leading to erysipelas and other diseases, is possible.
With lipid nephrosis, blood pressure is normal or low. There may be muffling of cardiac tones and bradycardia, but angiospastic symptoms and signs of heart failure are absent. Sometimes the liver is slightly enlarged. At late stages of the disease with pronounced edema, there is a decrease in the released urine to 400-300 ml per day, and a significant increase in its relative density.
Lipoid nephrosis is characterized by dysprosium-nemia and hypoproteinemia. Especially the albumen content in the blood plasma decreases, which leads to a decrease in the albumin-globulin coefficient to 1-0.5 and lower. Accordingly, the number of globulins increases in the blood, mainly due to alpha-2 and beta-globulins. The level of gamma globulins is lowered.
Severe lipidemia and cholesterolemia are permanent symptoms of the disease. The level of cholesterol in the blood plasma increases to 500 mg or more, the amount of lecithin and fatty acids increases. At the same time, hypochromic anemia, lymphocytosis, eosinophilia, increased ESR are observed.
In the late stages of the disease, tubular epithelial cells are destroyed with the development of connective tissue, subsequent atrophy and hyalinization of the glomeruli. As a result, the kidneys decrease in volume - a nephrotic wrinkled kidney is formed. Similar symptoms and the same course of the disease are seen in chronic nephritic nephritis.
The diagnosis of lipid nephrosis is based on the presence in the urine of a patient protein, the amount of which exceeds the normal values, the reduction of the total protein in the blood and the increase in the cholesterol content in it, as well as complaints of prolonged non-decreasing edema in the absence of hematuria, arterial hypertension and azotemia.
It is necessary to conduct differential diagnosis with the following diseases:
The patient is prescribed bed rest and diuretic drugs for fighting edema: lasix, hypothiazide, novorit and others. Recently, the main place in the treatment began to occupy corticosteroid drugs and immunosuppressants. The use of corticosteroids usually leads to a long-term remission, a decline in edema, a normalization of the structure of the walls of the glomerular capillaries with a decrease in their permeability and a decrease in the release of the protein by the kidneys.
As a means to increase the colloid-osmotic pressure of the plasma, the introduction of polyglucin is recommended. After the disappearance of swelling to improve the synthesis of protein can use steroid hormones. In all periods of the disease, it is necessary to use substitution therapy: vitamins and enzymes.
A protein diet is prescribed for a patient with lipoid nephrosis - at the rate of 2-2.5 g protein per kg body weight without taking into account edema, and vitamins. The amount of table salt is reduced to 1.5-2.5 g per day, moderately limited volume of fluid consumed. Also with the help of antibiotics, active treatment of foci of infection is conducted.
In view of the fact that lipid nephrosis develops very rarely as an independent disease, all its prevention is reduced to the prevention and timely disposal of the diseases that cause it, as well as the treatment of focal or chronic infection.