Overview
Nephrotic syndrome is a kidney disorder that causes the body to pass too much protein in the urine. This condition occurs due to damage to the small blood vessels in the kidneys responsible for filtering waste and excess water from the blood. Nephrotic syndrome leads to swelling, particularly in the feet and ankles, and increases the risk of other health problems. Treatment involves addressing the underlying cause and taking medications to prevent complications.
Understanding the disease
Symptoms
Symptoms of nephrotic syndrome include severe swelling, particularly in the eyes, ankles, and feet; foamy urine; weight gain due to fluid retention; fatigue; loss of appetite; and blood in the urine. Other possible symptoms include back pain, high blood pressure, and weakness or tiredness. If the disease leads to kidney failure, additional symptoms may include rashes, muscle cramps, stomach upset, confusion, and metallic taste in the mouth. It's important to see a doctor if you notice any symptoms related to nephrotic syndrome or kidney disease.
Risk Factors
Risk factors for developing nephrotic syndrome include:
- Medical conditions that can damage the kidneys, such as diabetes, lupus, amyloidosis, reflux nephropathy, and other kidney diseases.
- Certain medications, including nonsteroidal anti-inflammatory drugs and drugs used to fight infections.
- Infections that increase the risk of nephrotic syndrome, such as HIV, hepatitis B, hepatitis C, and malaria. It is important to note that while these risk factors can increase the likelihood of developing nephrotic syndrome, they do not guarantee that the condition will occur.
Development
Nephrotic syndrome develops when the clusters of tiny blood vessels (glomeruli) in the kidneys are damaged, leading to the leakage of excessive amounts of protein from the blood into the urine. This can result from various diseases and conditions, including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, diabetic nephropathy, and other causes. The specific cause of nephrotic syndrome can often be difficult to determine. Treatment for nephrotic syndrome involves addressing the underlying condition and managing symptoms with medications and dietary changes to prevent complications.
Assessment and Diagnosis
Triage
If you suspect nephrotic syndrome, you should see a doctor for a checkup. Symptoms of nephrotic syndrome include severe swelling, particularly around the eyes and in the ankles and feet, foamy urine due to excess protein, weight gain from fluid retention, fatigue, loss of appetite, and blood in the urine. It's important to get a proper diagnosis and treatment as nephrotic syndrome can increase the risk of infections and other health complications.
Diagnosis
Diagnosing nephrotic syndrome involves a series of tests and procedures. The main tests used to diagnose nephrotic syndrome include urine tests, blood tests, and a kidney biopsy. Urine tests can reveal abnormalities such as large amounts of protein in the urine. Blood tests can show low levels of the protein albumin and decreased blood protein levels overall. Additionally, creatinine and urea nitrogen levels may be measured to assess kidney function. In some cases, a kidney biopsy may be recommended to remove a small sample of kidney tissue for testing.
Management and Treatment
Complications
Possible complications of nephrotic syndrome include blood clots, high blood cholesterol and elevated blood triglycerides, poor nutrition, high blood pressure, and infections.
Prevention
Nephrotic syndrome cannot be prevented. It is a condition caused by damage to the glomeruli, which is the part of the kidney responsible for filtering blood. However, you can take steps to maintain overall kidney health and reduce the risk of complications, such as high blood pressure and high cholesterol. This may include working with your doctor to manage underlying medical conditions and following a healthy lifestyle with a balanced diet and regular exercise.
Treatment
Treatment for nephrotic syndrome typically includes addressing the underlying cause of the condition and administering medications to manage symptoms. The main goal of treatment is to minimize protein loss in the urine, reduce swelling, and prevent potential complications, such as infections and blood clots. Medications used to treat nephrotic syndrome may include:
- Corticosteroids: These powerful anti-inflammatory drugs can help reduce inflammation and swelling in the kidneys. Common examples include prednisone and dexamethasone.
- Immunosuppressants: These medications help regulate the immune system and can be used to treat conditions like IgA nephropathy. Examples include cyclophosphamide and mycophenolate mofetil.
- ACE inhibitors and ARBs: These medications can help manage high blood pressure and protect the kidneys from further damage. Examples include lisinopril, enalapril, and losartan.
- Diuretics: These medications help reduce fluid buildup in the body by increasing urine output. Examples include furosemide and hydrochlorothiazide.
- Cholesterol-lowering medications: As nephrotic syndrome can cause high cholesterol levels, medications like statins may be prescribed to manage cholesterol levels. It's essential to work closely with a healthcare professional to determine the most appropriate treatment plan based on the underlying cause and individual health needs.
Preparing for medical consultation
To prepare for an appointment for nephrotic syndrome, follow these steps:
- See your primary care doctor: Start by consulting your primary care doctor if you suspect nephrotic syndrome or if your doctor suspects you or your child may have the condition.
- Get referred to a nephrologist: If necessary, ask your primary care doctor for a referral to a specialist in kidney disease (nephrologist) for further evaluation and treatment.
- Prepare in advance: Ask your doctor's office if there are any specific preparations you need to make, such as fasting before a blood test or following any dietary restrictions.
- Make a list of symptoms and key personal information: Prepare a list of your symptoms, including any that seem unrelated to the reason for your appointment, and when they began. Also, include major stresses, recent life changes, and your family medical history.
- List all medications and supplements: Make a list of all medications, vitamins, and supplements you or your child takes, including dosages.
- Gather questions for your doctor: Compile a list of questions to ask your doctor during the appointment.
- Consider support groups: Ask your healthcare team about local support groups for kidney disease or contact the National Kidney Foundation (NKF) to learn about their Peers program, which offers telephone-based peer support. Remember to bring a family member or friend along to your appointment for support and to help you remember the information provided.