Why should it occure when sugar is well controlled. what is the treatment/prognosis
Nephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein (proteinuria at least 3.5 grams per day per 1.73m2 body surface area) from the blood into the urine.
Kidneys affected by nephrotic syndrome have small pores in the podocytes, large enough to permit proteinuria (and subsequently hypoalbuminemia, because some of the protein albumin has gone from the blood to the urine) but not large enough to allow cells through (hence no hematuria). By contrast, in nephritic syndrome, RBCs pass through the pores, causing hematuria.
According to NephCure, most often, Nephrotic Syndrome is defined by its primary diseases that attack the kidney’s filtering system. Doctors often call these diseases "idiopathic," which means that they have arisen without a known cause.
Monitoring and maintaining euvolemia (the correct amount of fluid in the body):
Monitoring urine output, BP regularly.
Fluid restrict to 1 L.
Diuretics (IV furosemide).
Monitoring kidney function:
do EUCs daily and calculating GFR.
Treat hyperlipidemia to prevent further atherosclerosis.
Prevent and treat any complications
Albumin infusions are generally not used because their effect lasts only transiently.
Prophylactic anticoagulation may be appropriate in some circumstances. Specific
Immunosuppression for the glomerulonephritides (corticosteroids, ciclosporin).
Standard ISKDC regime for first episode: prednisolone -60 mg/m2/day in 3 divided doses for 4 weeks followed by 40 mg/m2/day in a single dose on every alternate day for 4 weeks.
Relapses by prednisolone 2 mg/kg/day till urine becomes negative for protein. Then, 1.5 mg/kg/day for 4 weeks.
Frequent relapses treated by: cyclophosphamide or nitrogen mustard or ciclosporin or levamisole.
Achieving better blood glucose level control if the patient is diabetic.
Blood pressure control. ACE inhibitors are the drug of choice. Independent of their blood pressure lowering effect, they have been shown to decrease protein loss.
However, please do also consult/talk to a specialist, take care!
Diabetic Nephrotic syndrome a disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine.
It is a symptom of diabetic nephropathy, a complication of diabetes.
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