2. KIDNEYS
Kidneys is involved in the urinary system.
They are responsible for filtering the blood and removing excess fluid and wastes
for elimination in urine.
The functional unit of the kidneys are the nephrons, which consists the
glomerulus and tubules.
The glomerulus, a ball-shaped tuft of capillaries, serves as a gateway through
which blood components must pass to form filtrate.
The glomerulus and surrounding Bowman’s capsule function like a sieve,
retaining blood cells and most plasma proteins in the blood while allowing fluid
and small solutes to enter the nephron’s system of tubules.
As the filtrate moves through the tubules, its composition continuously changes
as some of its components are reabsorbed and returned to the blood via
capillaries surrounding the tubules;
the remaining substances contribute to the final urine product.
3.
4. Functions of the kidneys
Filtering the blood to remove excess waste to form
urine,
The kidneys regulate the extracellular fluid volume
and osmolarity(concentration of solutions expressed
as total number of solute per liter), electrolyte (ions)
concentrations, and acid–base balance.
They also excrete metabolic waste products such as
urea and various drugs and toxicants.
5. Other roles of the kidneys include
the following:
Secretion of the enzyme renin, which helps to regulate
blood pressure.
Production of the hormone erythropoietin, which
stimulates the production of red blood cells in the
bone marrow.
Conversion of vitamin D to its active form, thereby
helping to regulate calcium balance and bone
formation.
6. NEPHROTIC SYNDROME
Nephrotic syndrome refers to a condition caused by significant
urinary protein losses (proteinuria) that result from severe
glomerular damage.
The condition arises because damage to the glomeruli
increases their permeability to plasma proteins, allowing the
proteins to escape into the urine.
The loss of these proteins may cause serious consequences,
including edema, blood lipid abnormalities, blood coagulation
disorders, and infections.
In some cases, the nephrotic syndrome can progress to kidney
failure.
7. CAUSES OF NEPHROTIC SYNDROME.
Causes of the nephrotic syndrome include;
Glomerular disorders,
Diabetic nephropathy (Kidney disease as a result oof
increased blood sugar levels),
Immunological and hereditary diseases,
Infections (involving the kidneys or elsewhere in the body),
Chemical damage (from medications or illicit drugs),
Some cancers. Depending on the underlying condition.
8. CONSEQUENCES OF THE NEPHROTIC
SYNDROME
Although protein losses vary, proteinuria in adult patients may average
as much as 10 grams daily.
The liver tries to compensate by increasing its synthesis of various
plasma proteins, but some of the proteins are produced in excessive
amounts.
The imbalance in plasma protein concentrations contributes to a
number of complications which include the following;
Edema (swelling caused by excess fluids in the body tissues)
Blood Lipid and Blood Clotting Abnormalities:
Loss of immunoglobulins (antibodies) and vitamin D–binding protein
9. Edema:
Albumin (protein soluble in water) is the most abundant plasma
protein, and it is the protein with the most significant urinary
losses as well.
The hypoalbuminemia characteristic of the nephrotic syndrome
contributes to a fluid shift from blood plasma to the interstitial
spaces and, thus, edema.
Impaired sodium excretion also contributes to edema: the
nephrotic kidney tends to reabsorb sodium in greater amounts
than usual, causing sodium and water retention within the
body.
10. Blood Lipid and Blood Clotting
Abnormalities:
Individuals with the nephrotic syndrome frequently
have elevated levels of low-density lipoproteins (LDL) –
bad cholesterol
Furthermore, blood clotting risk is increased due to
urinary losses of proteins that inhibit blood clotting.
The nephrotic syndrome is associated with increased
risk of heart disease and stroke.
11. Other Effects of the Nephrotic
Syndrome:
The proteins lost in urine include immunoglobulins (antibodies)
and vitamin D–binding protein.
Depletion of immunoglobulins increases susceptibility to
infection.
Loss of vitamin D–binding protein results in lower vitamin D and
calcium levels and increases the risk of rickets in children.
If proteinuria continues, protein-energy malnutrition (PEM) and
muscle wasting may develop.
12. TREATMENT OF THE NEPHROTIC
SYNDROME
Medical treatment of the nephrotic syndrome requires diagnosis
and management of the underlying disorder responsible for the
proteinuria.
Complications are managed with medications and nutrition
therapy.
The drugs prescribed may include diuretics, angiotensin-
converting enzyme (ACE) inhibitors and angiotensin-receptor
blockers (which reduce protein losses).
Nutrition therapy can help to prevent PEM, alleviate edema,
and correct lipid abnormalities.
13. NUTRITION RECOMMENDATION TO
MANAGE NEPHROTIC SYNDROME
Protein and Energy:
Meeting protein and energy needs helps to minimize losses of muscle
tissue.
High-protein diets are not advised, however, because they can
exacerbate or worsen urinary protein losses and result in further
damage to the kidneys.
The protein intake should fall between 0.8 and 1.0 gram per kilogram of
body weight per day.
An adequate energy intake (about 35 kcalories per kilogram of body
weight daily) sustains weight and spares protein. Weight loss or
infections suggest the need for additional energy.
14. Lipids:
A diet low in saturated fat, trans fats (unhealthy fat that’s solid
at room temperature), and refined sugars may help to control
elevated low density lipoprotein LDL (bad cholesterol) levels.
Stay away from foods like, butter, palm and coconut oils,
cheese and red meat.
Dietary measures are usually inadequate for controlling blood
lipids, however, so physicians may prescribe lipid lowering
medications as well.
15. Sodium and Potassium:
Controlling sodium intake helps to control
edema; therefore, the sodium intake may be
limited to 1000 to 2000 milligrams daily.
If diuretics prescribed for the edema cause
potassium losses, patients are encouraged to
select foods rich in potassium.
NB: Diuretics are medicines that increase urine formation.
16. Vitamins and Minerals:
Multivitamin/mineral supplementation can help
patients avoid nutrient deficiencies.
Nutrients at risk include iron and vitamin D.
To reduce risk of bone loss, calcium
supplementation (about 1000 to 1500 milligrams
per day) may also be advised.