Nephrotic syndrome

Specialty of Internal medicine

What is it?     

Nephrotic syndrome is a condition in which the patient has protein in the urine, low blood protein levels, high cholesterol levels, and triglycerides, as well as a risk for developing blood clots and oedema. Proteins are very important for building bones, muscles, and other infection fighting tissues. When the kidneys do not function as they should, they leak albumin, a type of protein, into the urine. If a person doesn’t have enough albumin in their blood stream, fluid accumulates in the body and causes swelling in the legs, feet, and ankles.                 

Syndrome prognosis

Syndrome prognosis varies from patient to patient. Some people completely recover, while others have kidney disease for a long time, and may even need dialysis or a kidney transplant.

What are the symptoms? 

Oedema is the most common symptom and it normally appears in:

  • The face, around the eye area
  • Arms and legs, specifically the feet and ankles
  • The abdominal area.    

Other symptoms may include:

  • Skin rash or sores
  • Foamy urine
  • Loss of appetite
  • Weight gain due to fluid retention
  • Spasms.

Medical tests   

The specialist will first carry out a physical examination and lab tests to check kidney function. These may include:

  • Blood test for albumin
  • Metabolic blood tests
  • Blood urea nitrogen
  • Blood creatinine test
  • Urine test.

Fat may appear in the urine and cholesterol and triglyceride levels may increase. A kidney biopsy may be needed to find the cause. The following tests can rule out other causes:

  • Antinuclear antibody
  • Cryoglobulins
  • Serum complement levels
  • Glucose tolerance test 
  • Hepatitis B and C antibodies
  • HIV test
  • Rheumatoid factor
  • Electrophoresis of serum proteins
  • Serology for syphilis
  • Electrophoresis of urinary proteins.

Having the syndrome could affect the following tests:

  • Vitamin D levels
  • Serum iron
  • Urinary cylinders.  

What causes it?

Nephrotic syndrome is caused by different disorders that can damage the kidneys. This disease causes protein loss in urine. The most common cause in children is minimal change disease (MCD). In adults, the leading cause is membranous glomerulonephritis (MGN). In both diseases, the glomeruli of the kidneys are damaged. Glomeruli are the structures that filter waste and liquids.         

Other causes might be:    

  • Cancer
  • Diseases including: diabetes, lupus, myeloma, and amyloidosis
  • Genetic disorders
  • Immune disorders
  • Infections (tonsillitis, hepatitis, or mononucleosis)
  • Consuming certain drugs.      

Other kidney conditions may appear, such as:

  • Segmental and focal glomerulosclerosis
  • Glomerulonephritis
  • Mesangiocapillary glomerulonephritis.   

This syndrome can affect all ages. It tends to affect children aged between 2 and 6 years old. Women are more likely to develop this syndrome.      

How can it be prevented?    

There are certain conditions that can lead to nephrotic syndrome, so treating these is important to prevent it from developing.        

What is the treatment?

Treatment aims to lessen symptoms, prevent complications, and slow down kidney damage. To completely control nephrotic syndrome, the cause for it must be discovered. In some cases, the treatment will be life-long.      

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