¿Qué es el síndrome nefrótico? Causas, consecuencias y medidas nutricionales

26 de mayo de 2021 |
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¿Qué es el síndrome nefrótico? Causas, consecuencias y medidas nutricionales


¿Qué es el síndrome nefrótico?

El síndrome nefrótico, antes conocido como nefrosis, es una alteración renal de causas múltiples. Se caracteriza por proteinuria masiva y sostenida de más de 3,5 g/m2/día, retención renal de sodio, grados variables de edema, hipoalbuminemia, hipoproteinemia, hipertensión, desnutrición proteica y dislipemias con colesterol y triglicéridos altos. Suele asociarse a cierto grado de insuficiencia renal, aunque puede darse sin otras anomalías renales significativas.

Causas del síndrome nefrótico

La causa de la proteinuria, o excreción de proteínas plasmáticas en la orina, es el aumento de la capilaridad y permeabilidad de la membrana glomerular. Asimismo, puede ser causado por la enfermedad de cambios mínimos, glomeruloesclerosis focal, glomerulonefritis crónica, glomerulopatía membranosa, glomerulonefritis membranoproliferativa, diabetes mellitus, amiloidosis, lupus eritematoso sistémico, infecciones, reacciones alérgicas y fármacos.

Consecuencias del síndrome nefrótico

Pueden perderse de 3 a 16 g/día de proteína en adultos y hasta 50 mg de proteína/kg/día en niños. Cuando esta pérdida de proteínas supera la capacidad del cuerpo de sintetizarlas, se reduce la concentración plasmática de las mismas hasta en un 33% . En consecuencia, la presión coloidosmótica desciende significativamente, se fugan grandes cantidades de líquido de los capilares de todo el cuerpo hacia los tejidos y se provoca un edema generalizado.

edema generalizado
Edema generalizado

 

Medidas Nutricionales

Las medidas nutricionales en este grupo de pacientes se centran en mantener un balance nitrogenado adecuado, minimizar el edema,  disminuir la pérdida urinaria de albúmina, retardar la progresión  de  la  enfermedad  renal,  prevenir  la  desnutrición  de proteína y controlar  la hiperlipidemia.

¿Cómo se intentaba lograr? Hasta hace poco tiempo, se recomendaba el uso de dietas con alto contenido proteico, a fin de minimizar la pérdida de albúmina y conseguir balances nitrogenados positivos. Sin embargo, se ha demostrado que esta práctica puede exacerbar la proteinuria y desencadenar la progresión de una insuficiencia renal, sin mejorar la hipoalbuminemia.

¿Qué dice la ciencia? Diferentes estudios han señalado que una disminución dietética de proteínas desencadena la reducción de la proteinuria, con un aumento de las concentraciones plasmáticas de albúmina y una reducción de las cifras de colesterol y triglicéridos. Por ello, se recomienda una restricción moderada de proteínas en un rango de 0.6 a 0.8 g de proteína/kg/día, suplementado con 1.0 g/día de proteína de alto valor biológico por cada gramo de proteína urinaria que se pierda diariamente.

Otras Recomendaciones

Otra recomendación para lograr un estado nutricional óptimo en el paciente con síndrome nefrótico es  asegurar una cantidad adecuada de calorías. Se estima que 35 Kcal/Kg/día son suficientes para mantener el peso del paciente, a menos que este último sufra de obesidad. Así mismo, es recomendable que el 30% de la energía obtenida sea proveniente de los lípidos, principalmente en forma de grasas mono y poliinsaturadas, sin que las fuentes de grasas saturadas excedan el 10%; restringir el sodio a unos 2000mg/día según el grado de edema; y podría ser necesaria la suplementación de algunas vitaminas y minerales, como vitaminas del grupo B, calcio, potasio y zinc. La ingesta de líquidos no se suele limitar, a menos que la producción de orina sea de menos de 1 L/día. 

Cada paciente es diferente y el seguimiento y adecuada valoración son claves para un correcto tratamiento y mejorar su estilo de vida.

Este síndrome y otros son tratados en el Posgrado de Enfermedad Renal de 4Doctors Medical School. Si te gustaría saber pulsa aquí.

posgrado en enfermedad renal

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