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NEPHROTIC SYNDROME

Is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein[1] (proteinuria at least 3.5 grams per day per 1.73m2 body surface area)[2] 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, innephritic 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. Some of these cases are idiopathic.

SIGNS AND SYMPTOMS

It is characterized by proteinuria (>3.5g/day), hypoalbuminemia, hyperlipidemia and edema which is generalized & also known as anasarca or dropsy. Common among 2-6 years old boys. The edema begins in the face. Lipiduria (lipids in urine) can also occur, but is not essential for the diagnosis of nephrotic syndrome. Hyponatremia also occurs with a low fractional sodium excretion. Hyperlipidemia is caused by two factors:

• Hypoproteinemia stimulates protein synthesis in the liver, resulting in the overproduction of lipoproteins.
• Lipid catabolism is decreased due to lower levels of lipoprotein lipase, the main enzyme involved in lipoprotein breakdown.

A few other characteristics seen in nephrotic syndrome are:

• The most common sign is excess fluid in the body due to the serum hypoalbuminemia. Lower serum oncotic pressure causes fluid to accumulate in the interstitial tissues. Sodium and water retention aggravate the edema. This may take several forms:
  1. Puffiness around the eyes, characteristically in the morning.
  2. Pitting edema over the legs.
  3. Fluid in the pleural cavity causing pleural effusion. More commonly associated with excess fluid is pulmonary edema.
  4. Fluid in the peritoneal cavity causing ascites.
  5. Generalized edema throughout the body known as anasarca.
• Most of the patients are normotensive but hypertension (rarely) may also occur.
• Anemia (iron resistant microcytic hypochromic type) maybe present due to transferrin loss.
• Dyspnea maybe present due to pleural effusion or due to diaphragmatic compression with ascites.
• Erythrocyte sedimentation rate is increased due to increased fibrinogen & other plasma contents.
• Some patients may notice foamy or frothy urine, due to a lowering of the surface tension by the severe proteinuria. Actual urinary complaints such as hematuria or oliguria are uncommon, though these are seen commonly in nephritic syndrome.
• May have features of the underlying cause, such as the rash associated with systemic lupus erythematosus, or the neuropathy associated with diabetes.
• Examination should also exclude other causes of gross edema-especially the cardiovascular and hepatic system.

AYURVEDIC TREATMENT

Ayurveda is one of the most preferred treatment systems for nephritic syndrome because the allopathic treatment for the same includes the administration of corticosteroids in heavy dosage which can cause a number of side effects in the body.
Ayurveda believes that this condition is caused due to the vitiation of Pitta dosha in the body and various Pitta normalizing medications are used in the treatment of the same
Some of these medications include:

• Chandanasavam
• Chandaanaadi Wati

DIET

• Reduce sodium intake to 1000-2000 mg daily. Foods high in sodium include salt used in cooking and at the table, seasoning blends (garlic salt, Adobo, season salt, etc.) canned soups, canned vegetables containing salt, luncheon meats including turkey, ham, bologna, and salami, prepared foods, fast foods, soy sauce, ketchup, and salad dressings. On food labels, compare milligrams of sodium to calories per serving. Sodium should be less than or equal to calories per serving.
• Eat a moderate amount of high protein animal food: 3-5 oz per meal (preferably lean cuts of meat, fish, and poultry)
• Avoid saturated fats such as butter, cheese, fried foods, fatty cuts of red meat, egg yolks, and poultry skin.
• Increase unsaturated fat intake, including olive oil, canola oil, peanut butter, avocadoes, fish and nuts. Eat low-fat desserts.
• Increase intake of fruits and vegetables. No potassium or phosphorus restriction necessary.
• Monitor fluid intake, which includes all fluids and foods that are liquid at room temperature. Fluid management in nephrotic syndrome is tenuous, especially during an acute flare.