Understanding the Dual Perspectives Nephrotic Syndrome and Chronic Kidney Disease
With the usage of phrases “renal kidney disease” and “chronic kidney disease (CKD),” it is normal to feel concerned due to the context explained. The kidneys are specialized and essential organs, as they filter off metabolic wastes and excess fluids from the blood, balance electrolytes and even secrete important hormones. Alters to these functions can have consequences on one’s health. While used interchangeably in casual discussions, these phrases encapsulate a range of conditions.
This guide will focus on the aspects of kidney disease with the specific focus of exploring Nephrotic Syndrome an outlier of the bigger umbrella of Chronic Kidney Disease and its staging such as discussion deg at Stage Three Kidney Disease , Stage One Chronic Kidney Disease and sort of Stage Five CKD , the Treatments Available for CKD and more pertaining to 3B Stage Chronic Kidney Disease with a major genetic type , The Autosomal Polycystic Kidney Disease. It is important for those with these conditions and their family members to understand these differences.
Nephrotic Syndrome: A Kidney Disorder
Within the category of ‘Nephrotic Syndrome,’ a diseased state of the body is not present, but rather, it is an amalgamation of signs and symptoms that represent significant inflammation or insult to the kidneys’ filtering organ – a glomerulus. Such inflammation or damage leads to an abnormal protein loss, mainly albumin, from the blood into the urine. The main features of Nephrotic Syndrome are:
Protenuria: Excreting abnormal high quantity of protein in the urine (exceeding 3.5grams per day in adults). This is the most important feature.
Hypoalbuminemia: The protein albumin is at lower levels at the blood because of protein loss. Albumin is one of the most important proteins responsible for the oncotic pressure in the plasma.
Edema: Puffiness or swelling is observed in the ankles feet and legs, as well as in the face such as periorbital and abdominal region due to water retention resulting from low albumin.
Hyperlipidemia: An increased concentration of fats (cholesterol and triglycerides) in the blood. The liver increases the production of lipids in response to lowered plasma albumin concentration.
Other symptoms that one may experience consists of moderate to severe fatigue, increase of foamy urine because of protein content, and are more prone to infections and blood clots.
Causes of Nephrotic Syndrome:
Different forms of underlying primary or secondary kidney diseases may result in causing Nephrotic Syndrome. These may include but are not limited to:
Minimal Change Disease: Mostly children are affected, and it usually responds well to steroid treatment. The glomeruli appear normal under a light microscope.
Focal Segmental Glomerulosclerosis (FSGS): This can be primary or secondary to other diseases like HIV, sickle cell disease, or drug abuse. This is characterized by some glomeruli being scarred.
Membranous Nephropathy: Often the result of deposition of antibodies, this is the thickening of the glomerular basement membrane and can be primary or secondary to some other conditions like lupus or hepatitis B.
Diabetic Nephropathy: Long-term diabetes could lead to deterioration of the kidney.
Lupus Nephritis: A type of nephritis that occurs due to inflammation of the kidneys by Systemic Lupus Erythematosus (SLE).
Amyloidosis: The abnormal deposition of proteins, which includes amyloid, into the kidneys.
Detection of nephrotic syndrome can usually be made by obtaining a urine specimen for protein estimation, blood for albumin and lipids, and frequently a kidney biopsy is done to ascertain the other underlying causes. Treatment objectives include managing symptoms like edema, hypertension and hypercholesterolaemia, managing the underlying condition if feasible, and avoiding outcomes.
The umbrella term renal kidney disease
“Renal kidney disease” is a term used to describe a particular disease of the kidneys, which could be anything from a simple, self-resolving infection to a life threatening condition like chronic kidney failure. It even encompasses one of the lesser-known kidney diseases like nephrotic syndrome.
Chronic Kidney Disease (CKD): The disease of endless worsening.
Chronic Kidney Disease (CKD) describes a condition where there is an irreparable damage to renal tissues and therefore a gradual functional loss of leaping ability over prolonged periods of time. This condition can eventually result in kidney failure (End-Stage Renal Disease or ESRD). CKD continues to rise in incidence and poses a major burden to public health alongside escalating cardiovascular disease and further morbidities.
Now CKD is primarily determined by evaluating the patient’s blood for Glomerular Filtration Rate (GFR) which assesses the efficiency of the kidneys in purifying the blood. As the GFR rises, the stages become more severe indicating greater renal damage.
Stages of Chronic Kidney Disease:
The National Kidney Foundation (NKF) is known to have one of the most widely utilized staging frameworks for CKD:
Stage 1 CKD: Kidney damage with normal or high GFR (≥ 90 mL/min/1.73 m²). Alongside other signs of damage, kidney function at this stage is relatively good. However, there could be some indications of injury like protein leaking into the urine. Symptoms are usually absent.
Stage 2 CKD: Mild kidney damage with mildly decreased GFR (60-89 mL/min/1.73 m²). Healthcare professionals still do not get active symptoms from patients. There may be some information supporting damage and management might assist in controlling the underlying issue.
Stage 3 CKD: Moderate kidney damage with moderately decreased GFR (30-59 mL/min/1.73 m²). This stage is further divided into:
Stage 3A CKD: GFR of 45-59 mL/min/1.73 m².
Stage 3B CKD: GFR of 30-44 mL/min/1.73 m². At this point, people begin to show signs of symptoms like tiredness, swelling, and back discomfort. Repercussions add in the form of anemia and bone disease. Management strategies shift to active intervention, aimed at blood pressure control, anemia and bone health, and the potential onset of kidney failure.
Stage 4 CKD: Describe the condition in Stage 4 CKD. GFR is critically decreased (15-29 mL/min/1.73 m²) and GFR damage is severe. Symptoms are often more pronounced and complications are more pronounced. This stage is best described as pre-end stage renal disease where preparation for some form of kidney replacement therapy (either dialysis or transplant) is usually done.
Stage 5 CKD: Describe the condition in Stage 5 CKD. Kidney failure or End-stage ESRD is defined by GFR falling below 15 mL/min/1.73 m² or requiring dialysis. At this stage the patient has the renal form of advanced organ failure and therefore life sustaining treatment such as dialysis or a kidney transplant is required.
Chronic Kidney Disease Stage 1:
Chronic Kidney Disease Stage 1 refers to the period when the chronic process must be distinguished from an acute process. It is characterized by kidney damage with a normally or high GFR (≥ 90 mL/min/1.73 m²).
The most proximal aspect of management at this stage is:
Finding the underlying cause of damage: Determining the etiology for damage is crucial for treatment and targeted interventions.
Management of underlying causes if due to diabetes or hypertension: If the damage is secondary due to these conditions, tight control of these factors is critical.
Lifestyle changes: Proper nutrition, routine physical activity, and staying away from nephrotoxic agents is critical.
Monitoring: Consistent follow up visits and kidney tests are vital to assess how advanced the condition is.
Stage Three Kidney Disease:
Stage Three Kidney Disease indicates moderate kidney damage alongside a moderated decrease in GFR (30-59 mL/min/1.73 m²). This is a critical stage where the chances of developing complications become higher, and there is a likelihood of symptoms manifesting. As mentioned before, it is further subclassified into Stage 3A with GFR of 45-59 and Stage 3B Chronic Kidney Disease with GFR of 30-44.
Stage 3B Chronic Kidney Disease:
Stage 3B Chronic Kidney Disease constitutes a greater reduction of kidney function relative to Stage 3A. People at this stage are likely to start showing the following signs:
Excessive tiredness (fatigue) and weakness: because of waste products accumulation and anemia.
Swelling (edema): In the lower limbs and feet.
Altered urinary patterns: An increase or decrease in urination patterns, especially at night.
Back pain: especially in conditions where polycystic kidney disease is involved.
Difficulty falling asleep (Insomnia): toxin accumulation.
Far more common complications requiring active management are anemia (low red blood cell count), bone disease (as a result of insufficient activated vitamin D and phosphate regulation), and increased hypertension. At this stage, treatment primarily focuses on:
Managing the progression of chronic kidney disease: Achieved through tight control of blood pressure, management of diabetes if present, and other lifestyle changes.
Managing the complications: Treating anemia with erythropoiesis-stimulating agents; treating bone disease with phosphate binders and vitamin D analogs; treating hypertension with ACE inhibitors or ARBs.
Restriction of dietary protein, sodium, potassium, and phosphorus as directed by a renal dietitian.
Preparing the patient: Educating the patients on other potential options like dialysis or kidney transplant and discussing their possible future.
Kidney Disease Stage 5:
This is the most progressive stage of CKD. As the GFR falls below 15 mL/min/1.73 m², the kidneys are incapable of functioning and the body is unable to sustain life without replacement kidney therapy (dialysis or transplant).
Symptoms in Stage 5 are usually extreme and may include:
- Extreme fatigue and weakness.
- Severe swelling.
- Nausea and vomiting.
- Decrease in appetite along with weight loss.
- Itching.
- Muscle cramps.
- Difficulty in breathing.
- Changes to mental status like confusion or seizures.
Chronic Kidney Disease Treatments:
Treatment options for Chronic Kidney Disease differ according to the stage and the reason for the disease. The primary focuses of any treatment is to:
- Restrict the progression of the kidney disease.
- Take control of the complications.
- Get rid of the symptoms.
- Prepare for potential kidney failure.
Treatment options include:
Controlling the Underlying Factors: Keeping diabetes and hypertension in check is very important considering they are the leading causes behind CKD.
Lifestyle Changes:
Diet modifications: Following dietary restrictions such as recommended sodium, potassium, phosphorus, and protein intake by the renal dietitian.
Fluid restrictions: Required in the later stages.
Exercise: To some extent is recommended.
- Quitting smoking.
- Weight management.
Medications:
ACE inhibitors and ARBs: Aid in regulating blood pressure while protecting kidney function.
Diuretics: Assist in alleviating fluid retention and swelling.
Erythropoiesis-stimulating agents (ESAs): Implemented in treating anemia.
Phosphate binders: Limit the levels of high phosphate and control the diseases associated with bones.
Vitamin D analogs: Enhanced calcium absorption as well as bone health.
Bicarbonate: Used to treat metabolic acidosis.
Other medicines: Used in treating particular symptoms and complications.
Kidney Replacement Therapy (for Stage 5 CKD):
Dialysis: Replaces the natural filtering of the kidneys by removing waste products and excess fluid from the blood. Types include hemodialysis and peritoneal dialysis.
Kidney Transplant: The surgical removal of a diseased kidney and its replacement with a healthy kidney from a deceased or alive donor.
Autosomal Polycystic Kidney Disease (ADPKD): A Genetic Disorder
ADPKD is one of the most prevalent genetic disorders which involves the development of several cysts in the kidneys. Gradually, these fluid-filled cysts emptying into the kidneys may enlarge over time to compress some parts of the normal kidney tissue, progressively declining its function. Most cases of ADPKD are caused due to sure inheritance, which means that one only needs to get a single copy of the mutated gene from any one of the parents to suffer from the disorder.
Key features of ADPKD:
Multiple kidney cysts: These are the hallmark of the disease.
Kidney enlargement: Due to increasing number and size of cysts, kidneys can turn out to be disproportionately and disproportionately enlarged thanks to their significantly increased number and size.
Progressive loss of kidney function: Damage to CKD from the cysts’ compression of kidney tissues will ultimately result in kidney failure among many people.
Other organ involvement: The liver, pancreas, and spleen are other organs where cysts may form.
Associated conditions: Brain aneurysms, high blood pressure, diverticulosis, and mitral valve prolapse are some conditions that can occur with ADPKD.
Managing ADPKD:
- ADPKD currently has no cure, and management is focused on:
- Controlling the progression of kidney disease: Keeping the patient’s blood pressure well controlled is a key factor.
- Controlling discomfort: Rupture or bleeding of a cyst can lead to significant pain.
- Controlling infection: People with ADPKD tend to have more kidney infections.
- Managing complications: Like other forms of hypertension and other associated conditions.
- Slow cyst development in some adults with quickly progressing ADPKD: Prescribed to these people is tolvaptan.
- Ultimately, replace kidney therapy: Most people with ADPKD will need a kidney or will go on dialysis.
Conclusion:
Understanding the different nephrotic syndrome and chronic kidney disease requires deep comprehension of their components and myriad features. Nephrotic syndrome is a singular syndrome of protein loss, while chronic kidney disease describes a more advanced and multifaceted kidney injury with several stages. Some conditions like Stage 3B CKD are more complex and require more strict management, while end-stage renal failure, also referred to as Stage 5, requires kidney replacement therapy. Autosomal Polycystic Kidney Disease illustrates how some forms of kidney diseases are hereditary in nature.
For patients, the active and effective collaboration of healthcare providers, an early diagnosis coupled with chronic disease management can significantly mitigate the advancement of kidney disease, optimally manage its complications, and enhance the quality of life for affected individuals. Sustained research is encouraging for finding better and more effective therapeutic options.
Disclaimer: The information shared in this blog post is intended to provide a basic overview of nephrotic syndrome and chronic kidney disease and does not constitute a recommendation for medical treatment. Always seek the advice of a qualified healthcare professional to obtain a diagnosis and medical care for any health condition.
