Wetin kin apin to yu kidni filta? Lɛ wi lan bɔt Glomerular Disease!

Yu dɔn ɛva fil lɛk se yu de pas urine we gɛt fom? Ɔ yu kin fil lɛk se yu fes ɛn yu yay kin ful-ɔp smɔl we yu wek na mɔnin? Dis kin bi bikɔs ɔf wan prɔblɛm we de wit di smɔl smɔl filta sistɛm we de na wi kidni, we dɛn kɔl di glomeruli. Tide wi go tɔk bɔt dis sik we dɛn kɔl Glomerular Disease.

Wetin na Glomerular Disease?

Fɔ tɔk am simpul wan, Glomerular Disease na sik we kin kam wit sɔm tin dɛn we kin afɛkt di glomeruli, we na wan nɛtwɔk we gɛt smɔl smɔl blɔd vesel dɛn na wi kidni, we na di ‘filtering units’ na di kidni. Dɛn glomeruli ya na di wan dɛn we de filta dɔti tin dɛn we de kɔmɔt na wi blɔd ɛn pul di wata we pasmak. So, we dɛn glomeruli ya dɔn pwɛl ɛn nɔ ebul fɔ wok fayn, wi kin kɔl am Glomerular Disease.

Bɔrku sik ɛn kɔndishɔn kin pwɛl dɛn glomeruli ya. Tu men wɔd dɛn de we dɛn kin yuz fɔ tɔk bɔt dis damej:

• Glomerulonephritis: Dis na inflamɛns ɔ swel na di glomeruli.
• Glomerulosclerosis: Dis na di skata ɔ tik we di glomeruli de tik.

Glomerular Disease kin pwɛl yu kidni, ɛn sɔm tɛm, i kin ivin mek yu kidni nɔ wok fayn . So i rili impɔtant fɔ no bɔt dis.

Wetin dɛn glomeruli ya na wi kidni dɛn de du?

Tink bɔt am dis we: wi kidni dɛn tan lɛk di tu men filta dɛn na wi bɔdi. Dɛn tu ɔgan dɛn ya we tan lɛk bin de na di tu say dɛn na wi bak, jɔs dɔŋ wi rib kech.

Blɔd kin go insay wi kidni dɛn tru di at. we dεn go insay di kidni dεm, dεn at dεm ya de sheb mכr εn di bכdi de fכlכ insay wan sכm sכm sכm bכdi we lεk mεsh we dεn kכl glomeruli. εvri glomerulus (wan wכd) kכnekt to wan sכmכl wata we de kכlekt wata, we dεn k כl tubule . Wi kin kɔl dis wan glomerulus ɛn tubule unit nɛfrɔn . Dɛn se na lɛk wan milyɔn dis kayn nɛfrɔn dɛn de na wan kidni. Yu kin imajin dis kayn dilik sistɛm!

di glomeruli dεm we de wok fayn fayn wan de kip di bכdi sεl dεm εn di protin dεm na di bכdi sistεm. Na bikɔs na dɛn wi bɔdi nid. di sem tεm, di glomeruli de filta di west prodak dεm εn εkstra wata εn sεnd da likwid de to di tכbul. Na dat leta dɛn kin mek lɛk urine. afta dat di urine de pas tru big tכb dεm we dεn kכ l ureters εn kכlekt insay di blad.

Wetin kin apin to di kidni fכ wok we di glomerular sik de kam?

Naw lɛ wi si wetin kin apin we dis Glomerular Disease de kam. Dis sik kin pwɛl di Glomeruli. Dɔn dɛn nɔ kin ebul fɔ wok fayn fayn wan.

Wetin fɔ apin na dat di prɔtin ɛn rɛd blɔd sɛl dɛn kin de na di blɔd. Bɔt sɔm pan dɛn tin ya kin bigin fɔ lik kɔmɔt na di urine frɔm di glomeruli we dɔn pwɛl. Wan pan di wok we wan prɔtin we de na di blɔd lɛk albumin , de du na fɔ pul di ɛkstra wata we de kɔmɔt na di bɔdi go insay di blɔd ɛn ɛp fɔ mek di kidni dɛn filta am ɛn pul am lɛk urine. So, we di prɔtin we de na di blɔd go dɔŋ, dis ɛkstra wata kin bigin fɔ gɛda na di bɔdi. Na dat mek say dɛn lɛk di fes, an, leg, bɛlɛ, ɛn anklɛ kin swel.

Dɔn bak, di glomeruli dɛn we dɔn pwɛl nɔ kin ebul fɔ filta di dɔti fayn fayn wan. Dɔn dɛn dɔti dɛn de bigin fɔ gɛda na di blɔd. Dis nɔ fayn fɔ di bɔdi atɔl.

Wetin na de tin wae kin mek pɔrsin gɛt Glomerular Disease?

Bɔku tin dɛn de we kin mek pɔsin gɛt Glomerular Disease. Lɛ wi si wetin dɛn bi:

• Infekshɔn, mɛrɛsin ɔ kemikal we de ambɔg yu kidni, ɔ ivin di mɛrɛsin we wi de tek kin afɛkt di kidni.
• Sik dɛm wae kin afɛkt di wan ol bɔdi, inklud di wan dɛm wae kin afɛkt di kidni dɛm. Fɔ ɛgzampul , dayabitis ɔ lupus .
• Sik dɛm we kin mek di nɛfrɔn ɔ glomerulus swel ɔ gɛt skata.
• Sɔntɛnde, i nɔ kin pɔsibul fɔ fɛn rizin. Tɛm dɛn de we tan lɛk dat.

Wetin na di sayn dɛm fɔ Glomerular Disease?

Okay, naw lɛ wi si wetin na di sayn dɛm fɔ dis sik. If yu gɛt wan ɔ mɔ pan dɛn sayn ya, yu fɔ wɔri:

• Foamy urine: Dis min se protin de insay yu urine. Wi kɔl dis prɔtinuria .
• Pink ɔ layt brawn urine: Dis min se blɔd de na di urine. Dɛn kɔl dis ɛmaturia .
• Swel rawnd di fes/ay (especially na mɔnin), an, fut, ɔ ankles (especially we di de dɔn). Dɛn kɔl dis swɛlin ɛdima .
• Ay blɔd prɛshɔn (Hypertension).

If yu gɛt sayn dɛn lɛk dis, i go fayn fɔ mek yu go to dɔktɔ ɛn go to advays.

Aw dɔktɔ dɛn kin no dis sik kɔrɛkt wan?

We yu go to dɔktɔ, i go aks yu fɔs bɔt di sayn dɛn we yu gɛt ɛn chɛk yu gud gud wan. Dɔn, dɛn kin du sɔm tɛst dɛn, lɛk:

• Urinalysis we dɛn kin du: .dis de chεk di protin lεvεl na di urine, if rεd bכdi sεl dεm de, εn aw di wayt bכdi sεl lεvεl de (dis kin εp fכ no if infεkshכn כ inflameshn de).
• Blɔd tɛst: Dɛn tin ya de chɛk fɔ si if di prɔtin nɔ de na di blɔd, di kriaytinin lɛvɛl (we de gi yu aidia bɔt aw di kidni de wok), ɛn di yuria naytrɔjen (we na west prɔdak). Dɛn kin kɔl bak di Glomerular Filtration Rate (GFR) , we na fɔ no aw yu kidni dɛn de filta di dɔti fayn fayn wan.

If dɛn lab tɛst ya sho se yu kidni dɛn dɔn pwɛl, yu dɔktɔ kin ɔda fɔ mek dɛn du ɔda tɛst dɛn:

• Ɔda blɔd tɛst: Fɔ chɛk fɔ si if pɔsin gɛt infɛkshɔn ɔ sik dɛn we pɔsin kin gɛt we i de fɛt insɛf .
• Imej test: Test lεk ultrasound kin chεk fכ eni abnכmaliti na di shep כ saiz fכ di kidni dεm.
• Kidni Bayopsi: Dis na fɔ tek smɔl pat pan di kidni we yu de yuz nidul ɛn luk am ɔnda maykroskɔp. Dis go ɛp fɔ no di rayt tin we nɔ rayt.

Difrɛn kɔndishɔn ɛn tritmɛnt dɛn we kin mek pɔsin gɛt Glomerular Disease

Bɔrku sik kin kam wit Glomerular Disease. Di men gol fɔ tritmɛnt na fɔ fɛn di ɔndalayn kɔz ɛn trit am, if i pɔsibul. Dis kin mek di kidni dɛn nɔ pwɛl mɔ. Naw lɛ wi luk sɔm pan de men sik dɛm wae kin mek pɔrsin gɛt Glomerular Disease, wit ɛgzampul ɛn tritmɛnt dɛm.

Di sik dɛn we pɔsin kin gɛt we i de fɛt insɛf

Dis na sik dɛm wae yu bɔdi in imyun sistɛm kin atak yu yone bɔdi. Dɛn sik ya kin afɛkt di wan ol bɔdi, ɔ na sɔm pat dɛn nɔmɔ na di bɔdi kin afɛkt. Na sɔm ɔtoimyun sik dɛm wae kin afɛkt di kidni dɛm:

• Systemic Lupus Erythematosus (SLE) (dεn kin kכl am jכs lupus): Dis כtoimyun sik kin afekt bכku pat dεm na di bכdi. We i afɛkt di kidni dɛn, i kin mek pɔsin gɛt wan sik we dɛn kɔl lupus nephritis . Dis na inflameshn na di glomeruli. Dis inflamɛns kin mek skata ɛn di kidni dɛn kin stɔp fɔ wok fayn fayn wan. Di tritmɛnt inklud mɛrɛsin dɛn we de mek di bɔdi nɔ gɛt bɛtɛ wɛlbɔdi lɛk Mycophenolate Mofetil ɔ Cyclophosphamide , wit wan kɔtikosterɔyd we dɛn kɔl Prednisolone .
• Di sik we dɛn kɔl Goodpasture’s Syndrome:Dis ɔtoimyun sik de atak di kidni ɛn di lɔng dɛn. Insay di kidni dɛm, i kin mek pɔsin gɛt glomerulonephritis, we na inflamɛns na di glomeruli. Dis kin mek di kidni dɛn pwɛl fɔ ɔltɛm. Di tritmɛnt inklud mɛrɛsin dɛn we de mek yu bɔdi nɔ gɛt bɛtɛ wɛlbɔdi ɛn plasmapheresis (we de pul di antibodi dɛn we de atak yu yon bɔdi) .
• IgA Nεfropati: Insay dis כtoimyun sik, wan antibodi we dεn kכl Immunoglobulin A (IgA) frכm yu imyun sistεm de dכpכsit insεf na di glomeruli. Dɛn dipɔsit ya kin mek pɔsin inflamɛns. Di tritmɛnt inklud mɛrɛsin dɛn lɛk Angiotensin-Converting Enzyme Inhibitors (ACE inhibitors) ɔ Angiotensin Receptor Blockers (ARBs) .

Nɛfraytis we pɔsin kin gɛt frɔm in mama ɛn papa

• Alport Syndrome: Dis na wan sik we pɔsin kin gɛt frɔm in mama ɛn papa. I kin mek yu nɔr de yɛri ɔr nɔr de si fayn wit di sik wae de mɛk pɔrsin nɔr de fil fayn. I kin afɛkt man ɛn uman. Man dɛn kin gɛt sik we nɔ de mɛn na dɛn kidni. Dɛn kin no am we dɛn ol twɛnti ia. We i ol 40 ia, di kidni dɛn kin nɔ de wok fayn atɔl. Mɛrɛsin fɔ kɔntrol blɔd prɛshɔn na di tritmɛnt.

Glomerular Disease we gɛt fɔ du wit infɛkshɔn

Sɔmtɛm, glomerular sik kin kam kwik kwik wan afta infekshɔn ɔdasay na di bɔdi.

• Acute Post-Infectious Glomerulonephritis (PIGN): Dis glomerular sik kin apin afta yu gɛt trot infɛkshɔn (Strep throat) ɔ wan skin infɛkshɔn we dɛn kɔl Impetigo (dis nɔ kin apin so ɔltɛm). di imyun sistεm de mek mכr antibodi dεm pas aw i nid fכ fכt di infεkshכn. dis antibodi dεm de go εn dכn dכpכt insay di glomeruli εn de pwεl dεm. Bɔku tɛm, dɛn nɔ nid spɛshal tritmɛnt. Bɔt i nɔ kin apin so ɔltɛm, i kin nid fɔ mek dɛn dayalayz di kidni ɔ transplant di kidni .
• Bacterial Endocarditis: Dis na infεkshכn na di layn na di at. Risach pipul dεm nכ sכri yet if di lεsin dεm na di kidni dεm na di imyun sistεm in rεspכns to di infεkshכn כ na sכm כda sik mεkanism. Dɛn kin gi antibayɔtik as tritmɛnt.
• Vayrɔs dɛn: Epataytis B , Epataytis C ɛnGlomerular sik kin kam bak bay vayral infεkshכn lεk di Human Immunodeficiency Virus (HIV). Sɔm patikyula tritmɛnt dɛn de fɔ ɛni sik.

Sklerotic Diseases - Sik wae de mek yu gɛt skata

• Glomerulosclerosis: Dis kכndyushכn na di ska (sklerכsis) na di glomeruli. Lupus ɛn dayabitis na tu ɛgzampul fɔ sik dɛn we kin mek pɔsin gɛt glomerulosclerosis.
• Nɛfropati we gɛt fɔ du wit dayabitis: Dis na di men tin we kin mek pɔsin gɛt glomerular sik ɛn fɔ mek di kidni nɔ wok fayn na Amɛrika. Di nɛfropati we gɛt fɔ du wit dayabitis kin mek di kidni dɛn gɛt skata ɛn i kin mek di glukɔs lɛvɛl go ɔp. di glukoz de mek di bכdi fכ fכlכ pasmak na di kidni dεm, i de put strεs pan di glomeruli in filtration fכnshכn εn i de mek di bכdi prεshכn go כp. Di tritmɛnt dɛn we dɛn kin yuz na fɔ tek blɔd prɛshɔn mɛrɛsin (especially angiotensin-converting enzyme inhibitors (ACE inhibitors) ɔ angiotensin receptor blockers (ARBs) ), ɛksɛsayz, ɛn it fayn it.
• Focal Segmental Glomerulosclerosis (FSGS): Dis kכndyushכn kin kכl ska (usually) na wan pat pan wan glomerulus. FSGS kin bi bikɔs ɔf wan sik we de na di sistɛm ɔ bikɔs dɛn nɔ no di kɔz. Di tritmɛnt na fɔ mek di blɔd prɛshɔn ɛn di kɔlɔstrel lɛvɛl go dɔŋ.

Ɔda Glomerular Disizin dɛn

• Membranous Nephropathy: Dɛn kin kɔl dis sik bak Membranous Glomerulopathy . Na di sɛkɔn tin we kin mek big pipul dɛn gɛt nɛfrɔpati na Amɛrika, afta di nɛfropathy we gɛt fɔ du wit dayabitis. i de sho se i gεt sכm tכ gεt antijen/antibodi dεm . dis kכndishכn de atak di mεmbran layεr na di glomeruli. Sɔm pipul dɛn kin wɛl if dɛn nɔ gɛt tritmɛnt. Sɔntɛnde dɛn kin tray fɔ yuz mɛrɛsin dɛn lɛk angiotensin-converting enzyme inhibitors (ACE inhibitors) , angiotensin receptor blockers (ARBs) , ɔ calcineurin inhibitors .
• Minimal Change Disease (MCD): Dis na wan kayn nefropathy. insay dis, we dεn egzamin am insay kidni bayopsi, i kכlכsכl nכ chenj de na di strכkchכ fכ di glomeruli כ di tisu dεm we de rawnd. Lipid (dɛn tin dɛn we gɛt fat) .I kin bi se i kin gɛt drɔp, bɔt i nɔ kin pwɛl di kidni. MCD kin divεlכp pan εni ej, bכt i kin bכku pan yכŋ pikin dεm. Di tritmɛnt inklud it we nɔ gɛt bɔku sɔl ɛn ACE inhibitor ɔ ARB . Bɔku tɛm, stɛroyd dɛn kin mek di sik bɛtɛ.

Yu tink se glomerular sik kin mek yu kidni nɔ wok fayn?

Yɛs, if yu kidni dɛn nɔ ebul fɔ pul dɔti tin dɛn na yu blɔd, dɛn kin gɛda na yu bɔdi. Dis bild-ap kin pwɛl yu kidni ɛn mek dɛn stɔp fɔ wok. dis lכs fכ fכnshכn kin apin wan wan (akyu) כ sכmtεm εn kכntinyu (krכnik). dipכnt pan di kayn glomerular sik, di kidni dεm kin lכs insay fכ de כ wik, כ i kin tek bכku bכku ia fכ sכmtεm i kin dכn.

• Acute Renal Failure (ARF): Dis na we di kidni nɔ de wok wantɛm wantɛm. ARF kin mek pɔsin in layf de pan denja, ɛn dɛn kin nid fɔ du dayalaysis as imejensi tritmɛnt fɔ mek di kidni wok bak. Fɔ sɔm pipul dɛm, di kidni kin wok bak afta dɛn dɔn trit di tin we mek di kidni nɔ wok fayn. No damej nɔ de fɔ ɔltɛm. Bɔt sɔm pipul dɛn we kin wɛl frɔm ARF kin leta gɛt kronik kidni sik (CKD) .
• Kronik Kidni Disease (CKD): Dis na wae yu kidni nɔr de woke fayn smɔl smɔl. Yu nɔ go gɛt ɛni sayn fɔ lɔng tɛm. Sɔm pan di sik dɛm wae kin mek pɔrsin gɛt CKD kin kɔntrol, bɔt dɛn nɔr kin ebul fɔ mɛn CKD. We di kidni dɛn dɔn pwɛl, dɛn nɔ kin ebul fɔ mek dɛn bak. CKD kin mek di kidni nɔ wok fayn.
• Tɔtɔl Kidni Fɛil: Dɛn kin kɔl am bak Ɛnd-Stej Rɛnal Disiz (ESRD) . Dis min se yu kidni dɛn dɔn lɛf fɔ wok fɔ ɔltɛm. If yu gɛt tɔtal kidni fayl, yu go nid dayalaysis - ɔ ɛmodayalis ɔ peritoneal dayalaysis - ɔ yu go nid fɔ transplant kidni fɔ mek yu kɔntinyu fɔ liv.

Wetin a fɔ ɛkspɛkt if a gɛt Glomerular Disease?

Fɔ no di sik kwik kwik wan ɛn fɔ trit am kwik na di bɛst tin ɔltɛm fɔ mek yu gɛt di bɛst rizɔlt. Di gol fɔ tritmɛnt na fɔ mek di kidni nɔ pwɛl ɔ fɔ kɔntrol aw i de go bifo. Mɛmba se if yu no di pɔsin kwik kwik wan, dat kin ɛp. If di damej bad bad wan ɛn di kidni dɛn nɔ wok, di wangren tin we dɛn kin du na fɔ dayalaysis ɔ fɔ transplant di kidni.

Yu tink se dɛn kin ebul fɔ avɔyd Glomerular Disease?

Bɔrku chenj de wae yu kin mek na yu layf fɔ ridyus yu risk fɔ gɛt sik dɛm wae de afɛkt yu kidni dɛm ɛn fɔ gɛt wɛl bɔdi. Dɛn tin ya na:

• Mek yu gɛt wɛlbɔdi wet.
• Ridyus di sɔl we yu de it; nɔ ad ɛkstra sɔl to it.
• Kip yu blɔd prɛshɔn ɔnda kɔntrol. Di target na 120/80 mmHg.
• If yu gɛt dayabitis, kɔntrol di shuga we yu gɛt na yu blɔd.
• Tek ɔl di mɛrɛsin dɛn we yu dɔktɔ gi yu jɔs lɛk aw dɛn tɛl yu fɔ tek, ɛn fala ɔl di gol dɛn we yu dɔn tɔk bɔt wit am fɔ mɛn yu.
• Lɛf fɔ smok.

Nɔto ɔl di tin dɛn we kin mek pɔsin gɛt glomerular sik dɛn kin ebul fɔ avɔyd. Bɔt jɔs afta yu bigin fɔ notis di sayn dɛm fɔ glomerular disease, go to dɔktɔ. I impɔtant fɔ fɛn di tin dɛn we kin mek yu gɛt tritmɛnt ɛn bigin fɔ trit yu kwik kwik wan. Tritmɛnt kin ɛp fɔ kɔntrol di damej we yu kidni dɛn gɛt ɛn mek i nɔ wɔs.

Wetin na Nɛfrɔsis ɔ Nɛfrɔtik Sindrom?

Nεfrosis, we dεn kכl bak nεfrotik sεndrכm, na wan kכlekshכn fכ simptom dεm. Bɔku bɔku prɔtin we de na di blɔd de kɔmɔt na di urine. Dis kin mek wata gɛda na di bɔdi. Di sayn dɛm na:

• Swel (edema), mɔ arawnd di yay, leg ɛn an.
• Di ay blɔd prɛshɔn.
• Di bɔku bɔku kɔlɔstrel lɛvɛl dɛn.
• di protin lεvεl dεm na di bכdi we dεn dכn dכn.
• di protin lεvεl dεm we de na di urine de inkrεs.

Di gol fɔ tritmɛnt na fɔ trit di ɔndalayn kɔz, if i pɔsibul. Di tritmɛnt inklud:

• dεn gi angiotensin-converting enzyme inhibitors (ACE inhibitors) כ angiotensin receptor blockers (ARBs) fכ kכntrכl bכdi prεshכn εn stכp di protin fכ pas insay di urine.
• Ridyus di sɔl we yu de it.
• Dɛn kin gi diuretik fɔ ridyus di wata we de na di bɔdi.
• Dɛn kin gi dɛn kɔtikosterɔyd ɔ ɔda mɛrɛsin dɛn we de mek pɔsin nɔ ebul fɔ fɛt di sik.
• Dɛn kin gi am mɛrɛsin fɔ mek di kɔlɔstrel nɔ bɔku.
• If yu gɛt ɔtoimyun sik, dɛn kin du plasmapheresis fɔ pul di antibodi dɛm we de atak yu yon bɔdi.

If di ɔndalayn kɔz fɔ nefrosis na di kidni sik, dɛn nɔ go ebul fɔ mɛn am. Bikɔs di glomeruli dɛn na di kidni dɛn nɔ de wok fayn, di dɔti tin dɛn ɛn wata kin gɛda na di blɔd. Di kidni dɛn nɔ de wok fayn. We di sik wɔs, di tritmɛnt na dayalaysis ɔ transplant kidni.

Ustɛm a fɔ go to dɔktɔ?

If yu gɛt sayn ɔ simptom fɔ Glomerular Disease, ɔ if yu notis ɛni chenj na yu wɛlbɔdi, mek shɔ se yu go to dɔktɔ. Nɔ ignore ivin di smɔl tin, bikɔs di mɔ yu no kwik, na di mɔ i izi fɔ trit.

Difrɛn sik ɛn kɔndishɔn kin pwɛl di glomeruli na yu kidni. I impɔtant fɔ no bɔt yu bɔdi so dat yu go go to dɔktɔ kwik kwik wan if yu notis ɛni chenj.

Di tin dɛn we impɔtant pas ɔl fɔ mɛmba frɔm dis atikul (Take-Home Message) .

Okay, so naw yu dɔn ɔndastand gud gud wan bɔt wetin wi bin de tɔk bɔt, Glomerular Disease. Na sɔm impɔtant tin dɛn we yu fɔ mɛmba:

• Glomerular disease na wan kכndyushכn we de kכmכt we di filta yunit dεm (glomeruli) na di kidni dεm dεn dכn pwεl.
• Yu fɔ no bɔt di sayn dɛm lɛk fɔm yu urine, blɔd na yu urine, swel, ɛn ay blɔd prɛshɔn. If yu notis dɛn tin ya, go to dɔktɔ wantɛm wantɛm.
• If yu gɛt sik dɛn lɛk dayabitis ɛn aypatɛnshɔn, i rili impɔtant fɔ kɔntrol dɛn fayn fayn wan fɔ protɛkt yu kidni.
• If dɛn no di sik kwik kwik wan, di tritmɛnt kin kɔntrol di damej we di kidni dɛn gɛt. So nɔ ignore ɛni sayn we de sho se yu gɛt dis sik.
• Fɔ kip yu layf fayn (fɔ it fayn, fɔ du ɛksɛsayz, ɛn fɔ avɔyd fɔ smok) kin ɛp fɔ protɛkt yusɛf frɔm dɛn kayn sik ya.

Yu kidni na tu pan di impɔtant pat dɛn na yu bɔdi. Tek kia ɔf dɛn. If yu geht eni prohblem, no fred foh tok to dokta, okay?

` Kidni sik, Glomerular sik, Glomerular sik, Kidni filtration, Glomeruli, Protein in urine, Blɔd na urine, Bɔdi swel, Ay blɔd prɛshɔn, Kidni failure, Nephrosis