Nephrotic syndrome natural history, complications and prognosis

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

Complications

  • 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). [1]

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).

References

  1. Brenner, Barry M. (editor) Brenner & Rector's The Kidney, seventh edition W.B. Saunders Company 2004 ISBN 0-7216-0164-2


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