- frothy URINEduring URINATION(indicates albu-
minuria) - edema (fluid accumulation in the tissues), most
noticeable upon awakening and often affecting
the face and the feet - fatigue
- loss of APPETITEin combination with increased
weight (weight gain results from edema) - HEADACHE
Some forms of nephropathy also cause painless
HEMATURIA (bloody urine). The diagnostic path
includes further urine tests as well as BLOODtests
to assess kidney function. The nephrologist may
perform a kidney biopsy to examine the nephrons
under the microscope, which reveals the micro-
scopic damage of nephropathy. The nephrologist
may also conduct diagnostic imaging procedures
such as COMPUTED TOMOGRAPHY(CT) SCANandINTRA-
VENOUS PYELOGRAM(IVP) to examine kidney struc-
ture and function.
Treatment Options and Outlook
Treatment targets the underlying condition with
the aim of slowing progression of the nephropathy
and preserving remaining kidney function. It is
critically important for people who have diabetes
or hypertension (or both) to maintain effective
control of these conditions through medication
therapy and lifestyle measures. Some people are
able to successfully manage the underlying condi-
tion and the nephropathy to avoid ESRD, though
often nephropathy progresses to require RENAL
DIALYSIS. Whether kidney transplantation is a
viable treatment option for ESRD resulting from
nephropathy depends on multiple factors, includ-
ing co-existing health conditions, age, and overall
health status.
Risk Factors and Preventive MeasuresDiabetes and hypertension combined cause more
two thirds of nephropathy in the United States.
The risk for nephropathy is particularly high for
people who have both these conditions. Prevent-
ing these conditions and appropriately and dili-
gently treating them when they develop mitigates
the risk for nephropathy. People who take long-
term NSAIDs to treat chronic conditions such as
OSTEOARTHRITIS should have regular blood and
urine tests to screen for early indications of
nephropathy, and work with their doctors to find
the lowest effective DOSE and least nephrotoxic
medication to manage the condition and its symp-
toms.
See also HEAVY-METAL POISONING; HEPATORENAL
FAILURE; NEPHRITIS; NEPHRON; NEPHROTIC SYNDROME;
RETINOPATHY.nephrotic syndrome A constellation of symp-
toms that result as a consequence of conditions
that damage the glomeruli within the renal
nephrons. The damage allows excessive protein to
move through the walls of the glomeruli into the
filtrate. The tubules are unable to reabsorb the
large protein molecules, so the body ends up
excreting the protein in the URINE(ALBUMINURIA).
The excessive excretion of protein results in
HYPOALBUMINEMIA, or low levels of ALBUMINin the
BLOODcirculation. The hypoalbuminemia allows
fluid to leave the blood circulation and enter the
interstitial tissues, where it accumulates to cause
edema (swelling). Because the blood volume is
now low, the KIDNEYScompensate by reabsorbing
higher levels of water and sodium.
Most people who have nephrotic syndrome
have diagnosed kidney disease so the underlying
cause is clear. When indications of nephrotic syn-
drome occur in someone who does not have kid-
ney disease, the diagnostic path begins with blood
and urine tests to assess kidney function. Further
diagnostic procedures then strive to identify the
underlying renal condition. Treatment targets the
underlying renal condition as well as symptoms
such as HYPERTENSION(high BLOOD PRESSURE) and
RENAL FAILURE. Treatment may include RENAL DIALY-
SISwhen renal function is significantly impaired.
The outlook depends on the underlying renal con-
dition and its response to treatment. Symptoms of
nephrotic syndrome generally resolve when the
underlying condition improves.
See also GLOMERULONEPHRITIS; GLOMERULOSCLERO-
SIS; MINIMAL CHANGE DISEASE; NEPHRITIS; NEPHRON;
UREMIA.nephrotoxins Substances such as medications or
environmental chemicals that damage the
glomeruli and the tubules within the nephrons ofnephrotoxins 211