Nephrotic syndrome or nephritis syndrome: Wich will develop into uremia?

Nephrotic syndrome or nephritis syndrome: Wich will develop into uremia?   Nephrotic syndrome and nephritis syndrome are very common glomerular diseases in the clinic, and they may both develop in the direction of uremia. If you ask who is more likely to develop uremia, it mainly depends on the above three aspects.

Nephrotic syndrome is a group of clinical syndromes composed of glomerular diseases with similar clinical manifestations, different etiologies and pathological changes. Its typical symptoms are massive proteinuria, high edema, hyperlipidemia and hypoproteinemia (ie “three highs and one low”), hematuria and elevated blood pressure may also occur. The patient’s 24-hour urine protein quantitative is greater than or equal to 3.5 grams . It can cause various complications such as renal damage, thrombosis and embolic diseases, bacterial infections and malnutrition.

Nephritis syndrome refers to a group of clinical syndromes characterized by hematuria, proteinuria, hypertension, and edema. Elevated serum creatinine may also occur. Common types include acute nephritis syndrome such as acute glomerulonephritis, rapidly progressive nephritis syndrome such as crescent nephritis, and chronic nephritis syndrome such as IgA nephropathy. In general, nephritis syndrome is mainly manifested by hematuria and proteinuria. The 24-hour urine protein quantitative is generally less than 3.5g, and hypertension and edema may not be obvious.

The above is only an explanation of the concept of these two syndromes, perhaps our nephropathy friends do not fully understand. For example, in general, minimal change nephropathy, membranous nephropathy and other manifestations of high edema are nephrotic syndrome, while IgA nephropathy and allergic purpura nephritis and other urine protein is not particularly high, mostly belong to nephritis syndrome. Of course, the same type of nephropathy can be manifested as nephrotic syndrome or nephritis syndrome. Such as lupus nephritis and IgA nephropathy.

So, how to distinguish between nephrotic syndrome and nephritic syndrome? To put it simply, just look at the level of these two indicators: first look at the 24-hour urine protein quantification, and second look at the plasma albumin. That is, in the manifestations of hematuria, proteinuria, edema, and hypertension, if the 24-hour urine protein quantification of adult patients is ≥3.5 g and plasma albumin ≤30g/L, it is nephrotic syndrome, otherwise it is nephritis syndrome.

Nephrotic syndrome and nephritis syndrome, both of them belong to glomerular diseases. In uremic dialysis patients, various glomerular diseases can be seen. In other words, whether it is nephrotic syndrome or nephritis syndrome, they may develop into uremia.

In nephrotic syndrome, there are some that can be completely cured, and some are very difficult to treat. Such as minimal change nephropathy, it is easy to cure and the prognosis is good; while membranous proliferative nephritis and diabetic nephropathy are more difficult to treat, and the prognosis is also poor. Similarly, in nephritis syndrome, there is a very good prognosis, such as acute glomerulonephritis. Many patients can be cured and the prognosis is good; there are also very dangerous conditions, such as rapidly progressive nephritis (crescent nephritis), which is more critical and the prognosis of most patients is also poor.

Therefore, if you ask: nephrotic syndrome or nephritis syndrome, who is more likely to develop into uremia? Mainly depends on the following three aspects.

1. Primary disease and pathological type

The primary disease that causes nephrotic syndrome or nephritis syndrome is different, and its development trend will also be different. Whether they are easy to develop into uremia is also related to the primary disease and pathological type. The primary disease is minimal lesions, mild lesions, grade 1 or 2 IgA nephropathy in primary glomerular disease, mild mesangial proliferative nephritis, and allergic purpura nephritis in secondary glomerular disease, etc. Most of them are not easy to develop into uremia. The primary disease is mesangial proliferative nephritis in primary glomerular disease, grade 5 IgA nephropathy, severe mesangial proliferative nephritis, and diabetic nephropathy and lupus nephritis in secondary glomerular disease, and hereditary Nephritis, etc., are more likely to develop into uremia.

2. Urine protein response to drugs and treatment

In patients with nephritis syndrome with high proteinuria and nephrotic syndrome patients with high proteinuria, the obvious manifestation of urine protein exceeding the standard is its outstanding performance. After using various protein-lowering drugs, if the patient has a very good response to the treatment plan adopted and can reduce the urine protein (to normal or to a lower level), the kidney disease will not develop, or its development speed Very slowly, it is not easy to develop into uremia, otherwise it is more likely to develop into uremia.

3. Whether it is combined with hypertension and its control

Patients with nephrotic syndrome and nephritis syndrome may have high blood pressure. If the combined blood pressure is significantly higher and it is difficult to control to reach the standard, or if effective treatment measures are not taken for hypertension, the patient’s blood pressure is still at a high level, which often indicates the condition Severe and poor prognosis, patients are more likely to develop uremia. In addition, combined with hyperuricemia and not well controlled, or frequent concurrent infectious diseases, etc., will make the patient’s condition more likely to develop in the direction of uremia.

Nephrotic syndrome and nephritis syndrome are very common glomerular diseases in the clinic, and they may both develop in the direction of uremia. If you ask who is more likely to develop uremia, it mainly depends on the above three aspects.

(source:internet, reference only)

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