Nephrotic Syndrome - Causes, Symptoms, Diagnosis and Prevention

Nephrotic Syndrome

Dr.Deodatta Shripad Chafekar profile Authored by Dr.Deodatta Shripad Chafekar on 11 Dec 2014 - 10:55.

Nephrotic Syndrome

Nephrotic syndrome or nephrosis refers to an alteration in kidney structure due to injury to the foot like processes in the inner lining of a mesh of blood vessels called glomerulus which is a part of the nephron, which is the basic unit of kidney responsible for filtration of blood and production of urine. Normally no protein leaks out in the urine. Nephrotic syndrome is characterized by excess excretion of protein in the urine (proteinuria) causing reduction in blood level of proteins and elevated levels of blood cholesterol and triglycerideand excretion of lipids in the urine.It is more common in children but also can be seen in adult population. Although it may affect anybody, people living with diabetes are at higher risk.

The pathophysiology behind Nephrotic syndrome involves damage to the network of blood vessels (glomeruli) responsible for filtration of blood. However, following diseases and conditions may damage the glomeruli causing Nephrotic Syndrome.

There can be primary and secondary causes.

Primary causes:

There is no co-existing or causative disease and is described on the basis of histopathology findings:

  • Minimal change disease
  • Focal segmental glomerulosclerosis (FSGS)
  • Membranous nephropathy
  • Hereditary nephropathies
  • IgA nephropathy

Secondary causes:

  • Diabetes mellitus causing diabetic nephropathy.
  • A chronic inflammatory disease like lupus erythematosus can damage kidneys (Lupus Nephritis).
  • Excess accumulation of amyloid proteins in the body (Amyloidosis) that causes injury to the glomeruli.
  • Viral infections, including HIV.
  • Taking certain high risk drugs and medications Example. Nonsteroidal anti-inflammatory drugs (NSAIDs) and anti-bacterial and/ or anti-viral drugs.
  • Conditions like Hepatitis, Malaria and other infections.

Complications:

Over a period of time, untreated or poorly managed Nephrotic syndrome may lead to the following complications:

  • Formation of blood clots in the blood vessel causing embolism
  • Malnutrition
  • Hypertension
  • Acute and / or chronic kidney failure
  • Increased risk of infections
  • Pulmonary edema
  • Congestive heart failure (CHF)

Common signs & symptoms that one may experience may include the following:

  • Swollen eyes, face, arms and legs, mainly feet and ankle.
  • Swollen abdomen and sometimes whole body.
  • Unusual foamy urine.
  • Sudden and unintentional weight gain.
  • Weakness.
  • Shortness of breath.
  • Abdominal and / or chest pain.

When to see a doctor?

It is advised to see your doctors if any of the symptoms listed above are persistent.

Diagnosis of Nephrotic syndrome may involve following tests and procedures:

Physical examination: To look for visible signs, including swelling in the feet and other symptoms like chest and abdomen pain.

Urine analysis: The occurrence ofelevated protein levels (greater than 3-3.5 g/24 hours) in the urine, indicates Nephrotic syndrome.

Blood tests: To look for decreased levels of blood proteins, especially albumin (<25 g/L.) and high levels of blood cholesterol (total cholesterol greater than 10 mmol/L) and triglycerides that indicates Nephrotic Syndrome.

Kidney function tests: Serum creatinine and blood urea may be done.Protein-creatinine ratio of >300-350 mg/mmol is a sign of an altered kidney function.

Kidney biopsy: A sample of kidney tissue is tested assess the damage to the kidney.

To identify the probable underlying cause, tests including Antinuclear antibody test, Cryoglobulins, glucose tolerance test, Hepatitis antibody test, ELISA, Serum protein electrophoresis (SPEP),  Urine protein electrophoresis (UPEP), etc. may be performed.

The treatment of Nephrotic syndrome aims to treat the underlying cause and the symptoms presented. Further, treatment is done to prevent possible complications like infections and formation of blood clots.  Approaches to treat the ailment may include following interventions:

Drugs and medications: Based on the symptoms experienced and the identified underlying cause, doctors may prescribe suitable medications.

These may include:

Corticosteroids in appropriate dosages to reduce the inflammation

Drugs to reduce protein excretion in the Urine / Anti-hypertensive drugs – Ex. Benazepril, captopril, enalapril, losartan, etc. may be given to reduce BP and so the protein excretion in the urine.

Diuretics – These help to expel the excess fluid accumulated in the body, thereby decreases the swelling. Ex. furosemide and spironolactone.

Cholesterol lowering drugs – These may include statins such as atorvastatin, simvastatin, etc.

Anticoagulant medications – To prevent blood clotting doctor may prescribe drugs like heparin or warfarin.

Immune system-suppressants – Doctor may prescribe drugs like Cyclosporine ,Mycophenolateto control the immune response and so the inflammation.

Diet recommendations

Certain dietary recommendations may help one to manage the altered kidney functions, thereby maintaining good quality of life. Basically, diet recommendation for Nephrotic syndrome aims to balance the protein loss caused due to excess excretion of protein in the urine.  The recommendations may include:

  • Cut down fat and cholesterol from your diet
  • Limit the intake of salt and other foods rich in sodium (500mg sodium diet is enough)
  • Select adequate protein diet (It is recommended to consume 1 gram of protein per kilogram of body weight in a day) as high protein may damage the glomeruli
  • Choose lean protein - Eat raw eggs, skimmed milk, dry fish, chicken, sprouts, pulses, lentils, cheese, and so on.
  • Vitamin D rich food and supplements
  • Multi-enzyme supplements are often beneficial

As different clinical conditions may cause Nephrotic syndrome, preventing those conditions or treating them effectively at an early stage may help one to prevent Nephrotic syndrome. 

*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.