A B C D E F G H I J K L M N O P R S T U V W

NEPHROTIC SYNDROME

What is Nephrotic Syndrome ?

The two kidneys are situated at the back of the abdomen. They remove waste products and excess water from blood to make urine. The urine then passes down the ureter on each side into the bladder. Nephrotic syndrome is a collection of symptoms which occur when the kidneys become leaky and lose a lot of protein into the urine. As a result the level of protein in the blood falls. At the same time the kidneys cannot get rid of salt (sodium). Together, this results in fluid overload which causes swelling of the legs (oedema).

How does Nephrotic Syndrome occur ?

Many types of kidney inflammation, called glomerulonephritis, can cause nephrotic syndrome. In children, the commonest cause is a condition called minimal change glomerulonephritis. Nephrotic syndrome can also be part of diabetic kidney disease. Drugs such as gold or penicillamine can also cause it. Sometimes it happens with certain types of growths (multiple myeloma, lymphoma). It can be caused by other inflammations which affect the whole body (arthritis, systemic lupus erythematosus).

Why does Nephrotic Syndrome occur ?

The nephrotic syndrome due to glomerulonephritis is not well understood. More often, the nephrotic syndrome has occurred because of a particular drug, an infection, diabetes or a growth.

Treatment Involved for Nephrotic Syndrome

The condition is diagnosed by blood and urine tests. It is then important to find out what is happening in the kidney. This can only be done by taking a small piece of kidney to look at under the microscope (renal biopsy). Some types of glomerulonephritis causing nephrotic syndrome can be treated. In particular, this involves treatment with cortisone-like drugs called steroids. If the nephrotic syndrome is due to a secondary cause, then it may improve if this cause (such as drugs or growth) is removed or treated. Most children will be given cortisone-like drug treatment (usually prednisolone). A renal biopsy is only done if the child does not get better. If the child (or adult) is going to respond, they will suddenly start passing more urine and lose all swelling 2 days to 4 weeks later. The dose of prednisolone is then gradually reduced and stopped within a few weeks. The patient then may remain well (in remission) forever. The swelling may, however, recur a few days to a few years later; this is called relapse. If the condition frequently relapses, then alternative treatment may need to be considered. This often calls for the use of drugs called immunosuppressants. These are given for 2 months or so, during which time the white cell count in the blood needs to be carefully monitored. After such a course, the patient usually has a long-lasting remission.

NON-DRUG TREATMENT In many patients with nephrotic syndrome, the underlying cause (such as diabetes) cannot be completely treated or removed. Also some types of glomerulonephritis causing nephrotic syndrome do not respond to drug treatment. The swelling in these patients is then controlled by diuretics (water tablets). Sometimes the swelling is very resistant to these drugs: the patient may need to be admitted to hospital. Large doses of diuretics may then need to be given by injection. Sometimes albumin (protein) solutions are given intravenously (by a drip). This replaces some of the protein lost in the urine and often helps the diuretic treatment to work. Diet is also very important in patients with nephrotic syndrome. Large quantities of protein are being lost in the urine. It is important to try and correct for this. Increasing the protein content of the diet and eating extra calories can be very helpful, and you may be asked to discuss your diet with a dietitian. It is also important to limit the amount of salt in the diet. If should not be added without tasting first, and preferably avoided altogether (one can buy salt substitutes which will need to be approved by the doctor). Hidden salt in foods such as bread and convenience foods need to be thought about.

During Treatment for Nephrotic Syndrome

There are two aims in the treatment of nephrotic syndrome. To control the swelling and to watch out for any worsening of kidney function. The response to diuretic treatment is best checked by weighing. If the weight goes up, then you are retaining fluid; if the weight goes down you are probably losing fluid. If a lot of weight is lost too quickly, you may feel dizzy when standing up. Some types of glomerulonephritis causing nephrotic syndrome may result in poor kidney function as well as the protein leak into the urine. Kidney function therefore needs to be regularly checked by blood tests. Sometimes kidney failure may occur (chronic renal failure). This produces fatigue, sickness and breathlessness. The doctor should be notified if any of the above symptoms occur. In the early stages, regular visits are needed: sometimes every week. Later, these visits can be reduced. When in remission, such visits are no longer necessary. You may be asked to return only if the swelling reappears.

After Treatment for Nephrotic Syndrome

If the nephrotic syndrome has been cured and gone into remission then there may be no more problems. Sometimes a relapse may occur: the leg swelling comes back. You must then tell your doctor. The tendency to retain fluid often becomes less over a period of time. After a year, although the kidney is still leaking protein, fluid overload no longer appears to be a problem. Either lower doses of diuretics, or even none at all may be necessary. Only the doctor can advise whether it is safe to stop them.

If Nephrotic Syndrome is Left Untreated

Without treatment, fluid overload occurs. The swollen legs can become infected and fluid accumulates in the abdomen. Kidney failure is also more likely to occur.

Effects on Family of Nephrotic Syndrome

The condition needs careful watching and diet. Friends and family can be important. They will be helpful in reminding you of the need for check-ups. They also need to know all the do's and don'ts for food preparation.