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Nephrotic Syndrome

Author:

Vineel Kumar
Touro University - California, US

This information is provided for educational and informational purposes only and does not constitute providing medical advice or professional services.

What are the kidneys and what do they do?

The kidneys are two bean-shaped structures located on either side of the backbone. Kidneys play a very important role in the human body.
Each kidney has a million little filters (called glomeruli) that act as a sieve. As blood flows through these filters, the good things (like red blood cells, protein, sugar, etc.) are retained while excess water and waste products are removed via urine.

The kidneys also maintain our blood pressure, provide building blocks to maintain our red blood cells (hemoglobin), and also activate vitamin D to maintain healthy bones.
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What is Nephrotic Syndrome?

Nephrotic syndrome is defined by abnormal loss of protein through the kidneys into the urine (greater than 3.5 grams per day in adults and greater than 50 mg/kg per day in children), leading to low protein levels (albumin, in particular) in the blood. Low albumin in the blood leads to fluid retention and swelling in some areas of the body, high cholesterol levels in the blood, increased risk for blood clots, and increased risk for infections. Some main causes of nephrotic syndrome include: 
 
  • Minimal change disease: This is the most common cause of nephrotic syndrome in young children.
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  • Focal segmental glomerulosclerosis (FSGS): Caused by scarring of the kidney’s glomeruli, either immune-mediated, due to genetic causes, or due to several factors combined. This is a common cause of nephrotic syndrome in adults. Several conditions can result in this particular disease.
     
  • Membranous nephropathy: This occurs due to the thickening and damage of certain parts of the glomeruli. 

Who is at risk for  Nephrotic Syndrome? 

Children and adults of all ages can be affected by nephrotic syndrome. However, some groups may be at higher risk depending on the underlying cause of nephrotic syndrome. 

What are the signs and symptoms of Nephrotic Syndrome?

Signs and symptoms of nephrotic syndrome may include:

 

  • Foamy urine due to protein present in urine

  • Swelling (edema) throughout the body, including legs and face 

  • Weight gain due to excess fluid in the body

  • Tiredness

  • Loss of appetite 

  • High cholesterol levels 

  • High blood pressure 

  • Anemia 

  • Increased risk for infections 

  • Increased risk for blood clots 

  • Many symptoms are attributed to the loss of proteins through the kidneys. 

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What tests will my doctor perform to diagnose Nephrotic Syndrome?

If your history and clinical examination suggest nephrotic syndrome, your doctor will arrange for blood and urine tests. Blood tests assess your kidney function, the level of protein (albumin, in particular) in your blood, your cholesterol levels, and possibly a panel of tests to check for any potential causes leading to the condition. Urine tests are done to check for protein losses. Sometimes your doctor may require a 24-hour urine collection to quantify the amount of protein lost in the urine accurately. This can also be checked on a single urine sample. 
Your doctor may arrange an ultrasound scan of your kidneys.  Usually, a kidney biopsy is required to confirm the diagnosis. 

Doctor and Patient

Treatment of  Nephrotic Syndrome

The treatment of nephrotic syndrome depends on the underlying cause. Management will vary among the adult and pediatric populations. 


Treatment also varies depending on symptoms and the extent of kidney damage. Blood pressure medications can help lower blood pressure and reduce protein loss. Diuretics can be used to reduce swelling. Statins can be prescribed to lower cholesterol. Blood thinners may be used if patients develop blood clotting disorders. Finally, patients must be updated on their vaccinations due to the increased risk of infections. In some patients, treating the underlying cause can lead to remission.   

Will I develop kidney failure if I have Nephrotic Syndrome?

The likelihood of developing kidney failure with nephrotic syndrome depends on the underlying cause. Patients with minimal change pathology have an excellent prognosis, and kidney failure is rare. Patients with focal segmental glomerulosclerosis have a poor prognosis. 40-60% develop end-stage kidney disease (ESKD) in 10-20 years. Of patients with membranous nephropathy, ~30-40% developed ESKD in ten years. If kidney failure does develop, then dialysis or a kidney transplant will be needed. 

Clinical trials for IgA vasculitis:

New treatments and therapies are being developed for kidney diseases. Ask your doctor if you want to participate in a clinical trial for Nephrotic Syndrome. More information is available at:  www.enrollmypatient.org 

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