Nephrotic syndrome natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Complications

• Renal vein thrombosis: In nephrotic syndrome there is an excessive urinary protein loss which is in turn associated with decreased antithrombin III. This leads to a relative rise in the activity of Factor II and Factor X and in increased tendency to thrombosis. Renal vein thrombosis is a manifestation of this hypercoagulable state. It is unclear why the renal vein is susceptible to thrombosis in patients with nephrotic syndrome.

• Infection: It is due to leakage of immunoglobulins, encapsulated bacteria such as Haemophilus influenzae and Streptococcus pneumonia can cause infection.

• Acute renal failure: Acute renal failure is due to hypovolemia. Despite the excess of fluid in the tissues, there is less fluid in the vasculature (the patient is intravascularly deplete. Decreased blood flow to the kidneys causes pre renal azotemia. Thus it is therapeutic challenge to reduce the total body fluid overload while maintaining ciculalatory euvolemia.

• Pulmonary edema: It is due to fluid leak associated with the low protein content of the serum, there can be non cardiogenic pulmonary edema causing hypoxia and dyspnea.

• Growth retardation: It does not occur in MCNS. It occurs in cases of relapses or resistance to therapy. Causes of growth retardation are protein deficiency(loss of protein in urine), anorexia(reduced protein intake), steroid therapy(catabolism).

• Atherosclerosis and related heart diseases
• Chronic kidney disease
• Malnutrition
• Fluid overload, congestive heart failure

Prognosis

The prognosis depends on the cause of nephrotic syndrome. It is usually good in children, because minimal change disease responds very well to steroids and does not cause chronic renal failure. However other causes such as focal segmental glomerulosclerosis frequently lead to end stage renal disease. Factors associated with a poorer prognosis in these cases include level of proteinuria, blood pressure control and kidney function (GFR).