Nephrotic Syndrome is a common disease in children involving Kidneys. It is characterized by massive proteinuria, which leads to hypoproteinemia/hypoalbunemia, hyperlipidemia with elevated cholesterols, triglicerides and other lipids, and edema. It can develop from gradual progression of a mild loss of protein in the urine (sometimes called microalbuminuria), or it can develop suddenly. It is a condition marked by very high levels of protein in the urine (proteinuria); low levels of protein in the blood; swelling, especially around the eyes, feet, and hands; and high cholesterol. Nephrotic syndrome results from damage to the kidneys' glomeruli. Childhood nephrotic syndrome can occur at any age but is most common between the ages of 1½ and 5 years. It seems to affect boys more often than girls. Normal urine should contain almost no protein. In nephrotic syndrome the leak is large enough so that the levels of protein in the blood fall. Nephrotic-range proteinuria, the urination of more than 3.5 grams of protein during a 24-hour period, or 25 times the normal amount, is the primary indicator of NS.
The name primary NS has replaced, in some circles, the older designation of idiopathic NS, but both terms denote a similar same vagueness as to cause. These diseases can damage the microscopic filtering units in the kidney called the glomeruli, causing the loss of protein from the body. The nephrotic syndrome is not itself a disease. But it can be the first sign of a disease that damages the kidney's tiny blood-filtering units, called glomeruli, where urine is made. Nephrotic syndrome can occur with many diseases, including the kidney diseases caused by diabetes mellitus, but some causes are unknown. Protein loss in the urine (proteinuria) is accompanied by low levels of important proteins, such as albumin, in the blood, increased levels of fats (lipids) in the blood, a tendency for increased blood clotting, and a greater susceptibility to infection. NS generally has a glomerular cause and is currently categorized into primary and secondary forms. It is a fairly benign disease when it occurs in childhood, but may lead on to chronic renal failure , especially in adults, or be a sign of an underlying serious disease such as systemic lupus erythematosus or a malignancy. More than 90% of children with nephrotic syndrome are successfully treated with steroids.
Causes of Nephrotic Syndrome
The comman causes of Nephrotic Syndrome include the following:
- Nephrotic syndrome is caused by various disorders that damage the kidneys, particularly the basement membrane of the glomerulus.
- Diabetes and, to a lesser extent, hypertension can cause diffuse damage to the glomeruli and can ultimately lead to NS.
- The most common cause in children is minimal change disease, while membranous glomerulonephritis is the most common cause in adults.
- It occurs due to loss of proteins in the urine in large quantities which reduces the amount of protein in blood.
- This condition can also occur as a result of infection, drug exposure, malignancy (cancer), immune disorders, or diseases that affect multiple body systems including diabetes, systemic lupus erythematosus, multiple myeloma, and amyloidosis.
- The syndrome may be caused by certain allergies, including allergies to insects and poison ivy.
Symptoms of Nephrotic Syndrome
Some sign and symptoms related to Nephrotic Syndrome are as follows:
- Hypercholesterolemia (high level of cholesterol in the blood).
- Edema over the legs which is pitting (i.e. leaves a little pit when the fluid is pressed out, which resolves over a few seconds).
- Loss of appetite.
- Facial swelling.
- A general feeling of illness (malaise).
- Hypoalbuminemia (low level of albumin in the blood).
- Weight gain (unintentional) from fluid retention.
- Fluid in the peritoneal cavity causing ascites.
- High blood pressure.
- Low levels of protein in the blood.
Treatment of Nephrotic Syndrome
Here is list of the methods for treating Nephrotic Syndrome:
- Corticosteroid, immunosuppressive, antihypertensive, and diuretic medications may help control symptoms.
- Antibiotics may be needed to control infections.
- Usually, the doctor will start your child on a drug called prednisone. Most children get better with this drug.
- Persons with lupus who have nephrotic syndrome or signs of worsening renal function can be treated with corticosteroids and other immunosuppressive medication.
- Oral prednisolone treatment is effective in controlling the protein loss in the urine which is the main problem in NS.
- Dietary modifcation, including sodium or salt restriction and lower protein intake, can benefit the symptoms of nephrotic syndrome as well.
- Blood thinners may be required to treat or prevent clot formation.
- Vitamin D may need to be replaced if nephrotic syndrome is chronic and unresponsive to therapy.