Overview Of Nephrotic Syndrome
Nephrotic syndrome (NS) is a group of symptoms that include protein in the urine, low blood protein levels in the blood, high cholesterol levels, high triglyceride levels, increased blood clot risk, and swelling.
Commonly Associated With
Nephrosis; Nephrotic syndrome
Causes Of Nephrotic Syndrome
Nephrotic syndrome is caused by different disorders that damage the kidneys. This damage leads to the release of too much protein in the urine.
The most common cause in children is minimal change disease. Membranous glomerulonephritis is the most common cause in adults. In both diseases, the glomeruli in the kidneys are damaged. Glomeruli are the structures that help filter wastes and fluids.
This condition can also occur from:
- Diseases such as diabetes, systemic lupus erythematosus, multiple myeloma, and amyloidosis
- Genetic disorders
- Immune disorders
- Infections (such as strep throat, hepatitis, or mononucleosis)
- Use of certain drugs
NS can occur with kidney disorders such as:
- Focal and segmental glomerulosclerosis
- Mesangiocapillary glomerulonephritis
- Nephrotic syndrome can affect all age groups. In children, it is most common between ages 2 and 6. This disorder occurs slightly more often in males than females.
Symptoms Of Nephrotic Syndrome
Swelling (edema) is the most common symptom. It may occur:
- In the face and around the eyes (facial swelling)
- In the arms and legs, especially in the feet and ankles
- In the belly area (swollen abdomen)
Other symptoms of nephrotic syndrome include:
- Skin rash or sores
- Foamy appearance of the urine
- Poor appetite
- Weight gain (unintentional) from fluid retention
Exams & Tests
The health care provider will perform a physical exam. Laboratory tests will be done to see how well the kidneys are working.
- Albumin blood test
- Blood chemistry tests, such as basic metabolic panel or comprehensive metabolic panel
- Blood urea nitrogen (BUN)
- Creatinine – blood test
- Creatinine clearance – urine test
- Fats are often also present in the urine. Blood cholesterol and triglyceride levels may be high.
A kidney biopsy may be needed to find the cause of the disorder.
Tests to rule out various causes may include the following:
- Antinuclear antibody
- Complement levels
- Glucose tolerance test
- Hepatitis B and C antibodies
- HIV test
- Rheumatoid factor
- Serum protein electrophoresis (SPEP)
- Syphilis serology
- Urine protein electrophoresis (UPEP)
This disease may also change the results of the following tests:
- Vitamin D level
- Serum iron
- Urinary casts
Treatment Of Nephrotic Syndrome
The goals of treatment are to relieve symptoms, prevent complications, and delay kidney damage. To control nephrotic syndrome, the disorder that is causing it must be treated. You may need treatment for life.
Treatments may include any of the following:
- Keeping blood pressure at or below 130/80 mm Hg to delay kidney damage. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are the medicines most often used. ACE inhibitors and ARBs may also help decrease the amount of protein lost in the urine.
- Corticosteroids and other drugs that suppress or quiet the immune system.
- Treating high cholesterol to reduce the risk for heart and blood vessel problems — A low-fat, low-cholesterol diet is usually not enough for people with nephrotic syndrome. Medicines to reduce cholesterol and triglycerides (usually statins) may be needed.
- A low-sodium diet may help with swelling in the hands and legs. Water pills (diuretics) may also help with this problem.
- Low-protein diets may be helpful. Your provider may suggest a moderate-protein diet (1 gram of protein per kilogram of body weight per day).
- Taking vitamin D supplements if nephrotic syndrome is long-term and is not responding to treatment.
- Taking blood thinner drugs to treat or prevent blood clots.