Nephrotic Syndrome

Nephrotic syndrome is a kidney disorder that makes the body release excessive protein in urine. This serious condition affects 2 to 7 new cases per 100,000 children under 18 years old each year. The condition can develop in adults, too. When kidney damage occurs, it leads to various symptoms like low blood albumin levels and high blood lipids.

Doctors can't cure nephrotic syndrome, but patients can manage their condition better by knowing its symptoms, causes, and treatments. The condition's telltale signs include severe swelling around the eyes, ankles and feet, along with foamy urine. Patients often experience weight gain from fluid retention, feel tired, and lose their appetite. These symptoms appear because the kidney's filtering units get damaged and let protein leak into urine instead of keeping it in the bloodstream.

The condition raises the risk of infections and blood clots significantly. Research shows that people with nephrotic syndrome are almost 10 times more likely to develop venous thromboembolism than the general population. The good news is that proper medication and regular guidance from healthcare providers can help control these symptoms. Children with this condition have an even better outlook - nephrotic syndrome typically goes away by their late teens or early twenties

What is Nephrotic Syndrome?

The kidney's filtering units (glomeruli) sustain damage in nephrotic syndrome, which causes excessive protein leakage into urine. Statistics show that nephrotic syndrome in children is more common than in adults.

Patients with nephrotic syndrome show several symptoms. These include protein in urine (proteinuria), low blood albumin levels (hypoalbuminemia), high blood lipids (hyperlipidemia), and severe swelling (oedema). The condition develops when glomeruli let 3 grams or more of protein leak into urine within 24 hours.

Types of Nephrotic Syndrome

Doctors classify nephrotic syndrome into two categories:

• Primary: Kidney diseases that affect only the kidneys cause this type.
• Secondary: Other diseases that impact multiple body parts lead to this type.

Minimal change disease commonly affects children. Black adults often develop focal segmental glomerulosclerosis. White adults typically experience membranous nephropathy.

Symptoms of Nephrotic Syndrome

Patients experience these common nephrotic syndrome symptoms:

• Swelling appears first around the eyes
• Legs, feet, and ankles become puffy
• Urine looks foamy
• Fluid retention leads to weight gain
• People feel tired and lose their appetite

Causes of Nephrotic Syndrome

Kidney diseases like glomerulosclerosis or glomerulonephritis cause primary nephrotic syndrome. The following are some secondary nephrotic syndrome causes:

• Diabetes
• Systemic lupus erythematosus
• Renal vein thrombosis
• Infections like HIV, hepatitis
• Certain medicines like nonsteroidal anti-inflammatory drugs (NSAIDs) or certain antibiotics
• Sometimes cancer triggers secondary cases.

Risk of Nephrotic Syndrome

• Children between 2-7 years face higher risks. 
• Boys have a higher tendency of nephrotic syndrome than girls.
• Adults with diabetes, specific medications or infections like HIV or hepatitis show increased vulnerability.

Complications of Nephrotic Syndrome

• Blood clots, infections, hypovolemic crisis, high cholesterol, acute kidney injury, and anaemia pose serious risks. 
• Thromboembolism remains a critical concern. 
• Research shows that nephrotic patients have a 3.4 times higher chance of developing venous thromboembolism.

Diagnosis

Doctors first use a dipstick test to check for protein in urine. A positive result leads to confirmation through a 24-hour urine collection. 

Blood tests reveal reduced albumin levels and higher levels of cholesterol in most cases. 

In certain cases, doctors perform a kidney biopsy to take a small tissue sample to examine with a microscope. This helps doctors learn about the mechanisms and choose the right treatment.

Treatment of Nephrotic Syndrome

The main goal is to target the mechanisms while handling symptoms. Steroids like prednisolone remain the standard treatment, especially in children. The treatment plan includes:

• Blood pressure drugs (ACE inhibitors) to reduce protein leakage
• Diuretics to decrease swelling
• Cholesterol-lowering medications
• Blood thinners to prevent clots

On top of that, patients need to limit their salt intake.

When to See a Doctor

You should call your doctor if you notice:

• Ongoing swelling, especially around the eyes and ankles
• Foamy urine
• Sudden weight gain
• Breathing difficulties

Get emergency care if protein levels stay at 3+ on dipstick tests for three days straight.

Prevention

Patients can take the following steps to reduce their risks:

• Keep your diabetes and high blood pressure conditions under control
• Take all antibiotics as the doctor instructs
• Get recommended vaccines, particularly pneumococcal shots

Conclusion

People with nephrotic syndrome face daily challenges, but good management can make a huge difference in their lives. This kidney condition can affect anyone and causes protein leakage, swelling and other uncomfortable symptoms.

Doctors diagnose this condition using urine tests, blood work, and sometimes kidney biopsies. The treatment focuses on controlling symptoms while addressing why they happen. Steroids remain the main medication, particularly for children. Blood pressure drugs, diuretics, and cholesterol-reducing medicines help manage symptoms too.

Diet makes a vital impact on recovery. Less salt intake helps control swelling. Careful monitoring helps prevent complications like blood clots and infections. Parents should know that their children's condition often improves by late adolescence.

Nephrotic syndrome just needs consistent care, and patients who stick to their treatment plans can lead normal lives. The key to managing this condition lies in regular check-ups, taking medicines as prescribed, and making lifestyle changes. Quick action makes a real difference - you should call your doctor right away if you notice persistent swelling, foamy urine, or unexplained weight gain.

Medical science hasn't found a cure yet, but proper care and strong connections with healthcare providers give patients the best chance at managing this kidney disorder effectively.

FAQs

What is a nephrotic syndrome diet?

A nephrotic syndrome diet includes: 

• Lower sodium intake
• Moderate protein intake—about 1 gram per kilogram of body weight daily. 
• Fresh fruits, vegetables, & whole grains are better choices than processed foods. 

What is the difference between nephrotic and nephritic syndrome?

Nephrotic syndrome causes heavy protein loss in urine, noticeable swelling and usually normal blood pressure. Nephritic syndrome, on the other hand, causes inflammation, blood in urine (hematuria), high blood pressure, and moderate glomerular damage. This difference helps doctors create specific treatment plans for each condition.

What is the first stage of nephrotic syndrome?

Children's faces usually swell first, then the swelling spreads to other body parts. Adults tend to develop dependent oedema first. Foamy urine often appears, which shows protein leakage.

What is the peak age of nephrotic syndrome?

Minimal change disease, the most common type, peaks at age 2½ years. The majority of cases appear by age 6, and boys get it twice as often as girls.
 

Dr. Shiv Shankar Sharma

MD, DM (Nephrology)
CARE CHL Hospitals, Indore

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