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Nephrotic Syndrome

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  3. Nephrotic Syndrome

Overview of Nephrotic Syndrome

The kidney is an important organ in the body that is involved in the process of excretion. Two bean-shaped kidneys are present in the abdomen area. Normally, kidneys clean the blood and remove waste material by making urine. They are also involved in the regulation of certain minerals such as Na, K, and Ca. 

The glomeruli network of tiny blood vessels is involved in the filtration of blood. In nephrotic syndrome (نیفروٹک سنڈروم) the glomeruli have been damaged resulting in too much loss of albumin (protein). This condition is associated with swelling on the ankles, feet, and around the eyes. This kidney problem increases the risks of infections and blood clots. Complications can be prevented by proper diet and medications. 

Occurrence of Nephrotic Syndrome

Nephrotic syndrome is the most common kidney problem in children around the world. According to reports, its incidence rate is 2-7/100,000 children. This syndrome often affects Asians and Africans suggesting that environmental and genetic factors can be the major contributors. 

Signs and Symptoms of Nephrotic Syndrome

Some common signs and symptoms of nephrotic syndrome are:

  • Severe swelling (edema), around the eyes and on ankles and feet
  • Weight gain due to fluid retention
  • Foamy urine, due to protein excretion in urine
  • Loss of appetite
  • Fatigue

Types of Nephrotic Syndrome

Causes of Nephrotic Syndrome

Nephrotic syndrome is often caused by injured glomeruli-tiny blood vessels in the kidneys.

Glomeruli filter the blood coming to the kidneys. It separates the substance required for the body from waste materials. Healthy glomeruli keep the albumin protein that maintains the level of fluid in the body from excreting in the urine. However, if these tiny vessels are damaged, the albumin starts to release in the urine and causes nephrotic syndrome.
Various conditions can cause glomerular damage, hence nephrotic syndrome, such as:

  • Diabetic Kidney Disease: Diabetes often damages the kidney, a condition known as diabetic nephropathy. This condition can further damage the glomeruli.
  • Minimal Change Disease: Minimal change disease occurs due to the loss of albumin in the urine. It affects normal body function. This condition can cause nephrotic syndrome in children. The exact cause of this disease is unknown.
  • Focal Segmental Glomerulosclerosis: This abnormality is associated with scarring of the glomeruli. It can occur due to genetic causes, certain medicines, or some unknown reason.
  • Membranous Nephropathy: Membranous nephropathy is a condition in which the walls of glomeruli are thickened. Thickening occurs due to the deposition of substances produced by the immune system. It can also occur due to other conditions such as lupus, malaria, cancer, or hepatitis B.
  • Systemic Lupus Erythematosus: This is a persistent inflammatory disease that can cause severe damage to the kidney.
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Risk Factors of Nephrotic Syndrome

There are some factors that can increase the risk of a nephrotic syndrome such as:

Certain Medical Conditions: There are certain medical conditions that can increase the risk of a nephrotic syndrome such as

  • Diabetes
  • Reflux nephropathy
  • Lupus
  • Kidney diseases
  • Amyloidosis

Certain Drugs: Certain medications such as nonsteroidal anti-inflammatory drugs or antibiotics can damage the glomeruli and cause nephrotic syndrome.
Certain Infections: Some viral infections can increase the risk of a nephrotic syndrome such as:

  • HIV
  • Hepatitis B
  • Hepatitis C
  • Malaria

Health-Related Complications of Nephrotic Syndrome

Nephrotic syndrome can cause some serious complications such as:

  • Blood Clots: With nephrotic syndrome, glomeruli are no longer able to filter the blood properly. Some proteins required to prevent clotting are also released from the body. This condition causes the development of blood clots in the veins.
  • Increase in Cholesterol Level: Due to nephrotic syndrome level of albumin is decreased in the blood. As a result, the liver started to produce albumin. However, along with albumin cholesterol and triglycerides are also released. This causes an increase in blood cholesterol levels.
  • Poor Nutrition: Too much decrease in albumin can cause malnutrition. It can result in weight loss, anemia, and vitamin D deficiency.
  • High Blood Pressure: Blood pressure can be increased due to the accumulation of waste and body fluids.
  • Acute Kidney Injury: If kidneys are no longer able to remove toxic wastes and extra fluid, it leads to acute kidney injury. In this condition, the kidney requires either dialysis or a kidney transplant.
  • Infections: People with nephrotic syndrome can easily develop certain infections.

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Prevention

There is nothing that can be done to prevent all the causes of nephrotic syndrome. But different measures can be taken in order to avoid damage to your glomeruli:

  • Manage your blood pressure and diabetes if you have any of them.
  • Make sure that you are getting all your vaccinations done for common infections. Especially if you work around people who have hepatitis.
  • Take your antibiotics if your doctor has prescribed them, even if you start to feel better.
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Diagnosis

Nephrotic syndrome can be diagnosed by the following tests and procedures:

  • Urine Tests: These tests help the doctor to determine the main cause of the symptoms appearing.
  • Blood Tests: Blood tests are performed to estimate the level of albumin. With nephrotic syndrome, the level of albumin and some other certain proteins is decreased. Drop-in albumin protein results in increased cholesterol levels in the blood. Overall kidney function can be assessed by the creatinine and urea levels in the blood.
  • Biopsy: In this procedure, a small piece of tissue is cut from the suspicious area of the kidney. Further, the cells are examined in the lab for the signs of nephrotic syndrome.

Treatment of Nephrotic Syndrome | When to Consult a Doctor

Treatment of nephrotic syndrome involves treating any medical condition that is responsible for nephrotic syndrome. 

Home Remedies

Certain diet changes can be helpful for nephrotic syndrome. You can consult a dietitian who suggests the following tips: 

  • Consume plant-based proteins that can be helpful in kidney disease.
  • Maintain your blood cholesterol level by minimizing the number of fats in your diet. 
  • Eat a low-salt diet to reduce swelling.
  • Minimize the consumption of liquids in your diet.

Medications used for treatment are:

High Blood Pressure

Control of high blood pressure is the best way to slow the progression of the disease and further kidney damage. High blood pressure can be controlled by: 

  • Taking a low-sodium and low-fat diet 
  • A diet with balanced calorie content protein
  • Exercise 
  • Reducing stress 

Medicines including angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are often recommended to control high BP.

Water Pills (Diuretics)

These diuretic pills reduce kidney swelling by extracting the fluid from the kidney. Diuretic medications usually include:

  • Furosemide 
  • Spironolactone (Aldactone)
  • Thiazides

Cholesterol-Reducing Medications 

Statins are often prescribed to lower cholesterol levels. These medications include:  

  • Atorvastatin (Lipitor)
  • Lovastatin (Altoprev)
  • Fluvastatin (Lescol XL) 
  • Pravastatin (Pravachol)
  • Simvastatin (Zocor)
  • Rosuvastatin (Crestor, Ezallor)

Blood Thinners or Anticoagulants

Most commonly nephrotic syndrome is treated with anticoagulants or blood thinners. These drugs can be injected or taken as pills to prevent clot development. These blood thinners can prevent clots from getting bigger. 

Heparin is usually injected intravenously. Some other blood thinners, such as enoxaparin or fondaparinux are injected intradermally. You may receive injectable anticoagulants for a few days, after which drugs such as warfarin or dabigatran are started. 

Immune System-suppressing Medications

Certain medications can be used to control inflammatory conditions that cause nephrotic syndrome. These drugs include: 

  • Rituximab (Rituxan)
  • Corticosteroids
  • Cyclosporine 
  • Cyclophosphamide

If you experience any signs and symptoms of nephrotic syndrome that are persistent and worrisome seek medical care and consult a nephrologist as soon as possible.

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