What is nephrotic syndrome?
Nephrotic syndrome is diagnosed based on certain features seen when a child (or adult) is examined as well as some laboratory findings.
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This includes finding a lot of protein in the urine (more than 3.5 grams per day), low protein levels in the blood, high cholesterol and triglyceride levels (certain types of fats seen in the blood) and physically, the person should be swollen, be it generalised or limited.
It is a disease of the kidneys - the paired organs responsible for the production of urine and the removal of certain waste products from the body.
Nephrotic syndrome can affect all age groups. In children, it is most commonly seen from age two to six. This disorder occurs slightly more often in males than females.
It is caused by various disorders that damage the kidneys, particularly a part of the kidney called the basement membrane of the glomerulus. This damage allows certain types of proteins (mainly small molecules) to leak out of the kidney into the urine. This explains why proteins are seen in the urine.
As a result of this leakage into the urine, the amount of proteins in the blood decreases. The body in an attempt to produce more proteins retains a lot more fats leading to the high levels of cholesterol in the blood.
The swelling results from the mismatched pressures between the blood vessels and the surrounding tissues largely due to the leakage of proteins from the blood.
Thus fluids are pushed and retained in the tissues instead of remaining in the blood vessels and that is what causes the generalised swelling.
Causes
The usual causes of nephrotic syndrome include diseases of the kidney itself, so-called primary kidney diseases. examples of such disease entities include minimal-change nephropathy and membranous nephropathy.
Nephrotic syndrome can also result from a systemic diseases - secondary causes. examples of such diseases include diabetes mellitus, lupus erythematosus, hepatitis B, HIV, malaria and sickle cell disease.
It can also be from birth where there are certain changes in genes code for certain vital proteins in the kidneys.
Certain drugs such as Non-Steroidal Anti-Inflammatory Drugs (NSAIDS), penicillamine etc are implicated in nephrotic syndrome.
Symptons
Generalised body swelling (edema) is the most common symptom. It may occur in the face, around the eyes, in the arms and legs, especially in the feet and ankles and the belly area.
Other symptoms include:
- Foamy appearance of the urine
- Unintentional weight gain from fluid retention
- Poor appetite
- High blood pressure.
Laboratory investigations that may be required include analysing the urine for amount of protein in the urine, blood urea and electrolytes to assess the kidney function, the lipid profile as well as the serum albumin levels.
Other tests such as sickle cell screen, hepatitis B&C screen, malaria test etc may be requested based on the suspicion of secondary causes of nephrotic syndrome.
Kidney biopsy may be needed to categorise the exact type of disease.
The goals of treatment are to relieve symptoms, prevent complications and delay progressive kidney damage. Treatment of the disorder that causes the condition is necessary to control nephrotic syndrome.
Treatment may be needed for controlling blood pressure is the most important measure to delay kidney damage. The goal is to keep blood pressure at normal levels.
High cholesterol levels should be treated to reduce the risk of heart and blood vessel problems. However, a low-fat, low-cholesterol diet is usually not as helpful for people with nephrotic syndrome.
Medications to reduce cholesterol and triglycerides may be needed in adults.
A low salt diet may help with swelling in the hands and legs. Water pills (diuretics) may also help with this problem even though used very cautiously.
Low protein diets may or may not be helpful. A moderate-protein diet (1 gram of protein per kilogram of body weight per day) may be suggested.
Vitamin D may need to be replaced if nephrotic syndrome is chronic and unresponsive to therapy.
Blood thinners may be required to treat or prevent clot formation.
There are a lot of complications that can happen but perhaps the most important of all is chronic renal or kidney failure therefore, nephronic syndrome must be well managed preferably by a specialist to avoid these complications.
