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Nephrotic Syndrome

Nephrotic syndrome is a warning sign which occurs when the clusters of small blood vessels in the kidney are damaged. As a result the kidneys excrete excess proteins in the urine and the levels of proteins in the blood are lowered. Additionally, the cholesterol and triglyceride levels are high in the blood. Nephrotic syndrome can lead to kidney failure over a period and needs a timely treatment.

Causes

Nephrotic syndrome results when there is damage to the filtering units of the kidneys called glomeruli. Glomeruli are the clusters of blood vessels supplying the kidneys. This damage can happen due to the below disorders:

  • Minimal change disease (primary cause in children)
  • Membranous glomerulonephritis (primary cause in adults)
  • Kidney disorders such as glomerulonephritis, focal and segmental glomerulosclerosis
  • Systemic lupus erythematosus
  • Multiple myeloma
  • Diabetic kidney disease
  • Certain genetic disorders
  • Immune disorders
  • Use of certain drugs
  • Cancer
  • Infections such as hepatitis or strep throat

Symptoms

The most common symptom of nephrotic syndrome is swelling or edema. This includes swelling of the face, arms, legs, feet, ankles and the belly region. Other symptoms may include:

  • Foamy urine due to the presence of proteins
  • Weight gain due to fluid retention
  • Poor appetite
  • Fatigue
  • Skin rashes or sores
  • Seizures

Risk factors

Nephrotic syndrome can occur at any age. In children it usually occurs between 2-6 years of age. The other risk factors of nephritic syndrome include:

  • Male gender
  • Medical conditions which cause kidney damage
  • Use of certain medicines such as non-steroidal anti-inflammatory drugs
  • Infections such as hepatitis B, hepatitis C, malaria, and HIV

When to consult the doctor?

If the symptoms of nephrotic syndrome become bothersome, then consult the doctor. Seek immediate medical help if seizures occur.

Diagnosis

The doctor needs certain laboratory reports to diagnose nephrotic syndrome. These include:

  • Urine tests to check the levels of proteins in urine
  • Blood tests to measure the levels of proteins, cholesterol and glucose in blood
  • Imaging tests such as an ultrasound to look for any abnormalities in the kidneys. This test helps to rule out other causes
  • Sometimes a kidney biopsy (i.e. a small sample of kidney tissue examined under microscope) may be needed to know the cause

Treatment

The main aim of the treatment is to reverse the condition and prevent further kidney damage. Treatment is based on the age and overall health of the patient. In some patients treatment may not be necessary. Treatment approaches include one or more of the following:

  • Medicines to suppress the body’s immune system such as corticosteroids and other drugs
  • Blood pressure lowering medicines to maintain the blood pressure at or below 130/80 mm Hg. This helps to prevent further damage and protects the kidneys.
  • Diuretics or water pills to remove excess fluids from the body and lower the blood pressure
  • Medicines to lower the cholesterol levels in the blood
  • Blood-thinning agents to dissolve the blood clots
  • Vitamin D supplements may be given to treat long-term nephrotic syndrome which does not respond to other treatments

Treatment may be necessary for a few months to years or sometimes for the rest of the life.

Complications

The below complications may result if nephrotic syndrome is not treated properly:

  • High blood pressure due to the buildup of waste materials
  • High cholesterol levels in blood
  • Formation of blood clots within the veins of the kidneys
  • Malnutrition may result due to the loss of proteins
  • Acute or chronic kidney failure
  • Increased risk of infections

Self care

The below self care measures can help to better manage nephrotic syndrome:

  • Taking all the medicines as prescribed
  • Going for regular checkups to the doctor
  • Taking flu shots every year and other immunizations as per the doctor’s recommendation
  • Certain dietary restrictions such as reducing the amount of protein rich food, taking low-salt diet to reduce swelling (i.e. edema) and lowering the amount of cholesterol and fat intake to control the cholesterol levels in blood
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