Overview
What Is Nephrotic Syndrome ?
It is the name given to a condition when large amounts of protein leak out into the urine. Normal urine should contain almost no protein. In nephrotic syndrome the leak is large enough so that the levels of protein in the blood fall.
Nephrotic syndrome is a condition marked by :
- Very high levels of protein in the urine, a condition called proteinuria
- Low levels of protein in the blood
- Swelling, especially around the eyes, feet, and hands
- High cholesterol
Causes
Nephrotic syndrome can be primary, affecting only the kidneys, or secondary, caused by a vast array of disorders that affect other parts of the body, most commonly diabetes mellitus, systemic lupus erythematosus, and certain viral infections. Nephrotic syndrome can also result from glomerulonephritis. A number of drugs that are toxic to the kidneys can also cause nephrotic syndrome, especially nonsteroidal anti-inflammatory drugs (NSAIDs). The syndrome may be caused by certain allergies, including allergies to insect bites and to poison ivy or poison oak. Some types of nephrotic syndrome are hereditary.
Diagnosis
A doctor bases the diagnosis of nephrotic syndrome on the symptoms, physical examination findings, and laboratory findings. Sometimes nephrotic syndrome is at first mistaken for heart failure in older adults because swelling occurs in both disorders and heart failure is common in older people. A laboratory test of urine collected over a 24-hour period is useful for measuring the degree of protein loss, but collection of urine over such a long period is difficult for many people to accomplish.
Alternatively, to estimate protein loss, a randomly collected urine specimen can be tested to measure the ratio of the level of protein to that of creatinine (a waste product). Blood tests and other urine tests detect additional characteristics of the syndrome. The level of albumin in the blood is low because this vital protein is excreted in the urine and its production is impaired. The urine often contains clumps of cells that may be combined with protein and fat (casts). The urine contains low levels of sodium and high levels of potassium.
How Is Nephrotic Syndrome Treated ?
In addition to addressing the underlying cause, treatment of nephrotic syndrome focuses on reducing high cholesterol, blood pressure, and protein in urine through diet, medications, or both. Two groups of blood pressure medications—angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)—also protect the kidneys by reducing proteinuria.
Some people may benefit from limiting protein in their diet to reduce the buildup of wastes in the blood.
Nephrotic syndrome may go away once the underlying cause, if known, has been treated. In children, 80 percent of cases of nephrotic syndrome are caused by a condition called minimal change disease, which can be successfully treated with prednisone. However, in adults, most of the time the underlying cause is a kidney disease such as membranous nephropathy or focal segmental glomerulonephritis, diseases that are treated with corticosteroids, immunosuppressive drugs, and, in some cases, cytotoxic agents. Unfortunately, these treatments do not always bring about remission of nephrotic syndrome. Depending on the disease, as many as half of the patients may develop chronic kidney disease that progresses to end-stage renal disease. In these cases, the kidneys gradually lose their ability to filter wastes and excess water from the blood. If kidney failure occurs, the person will need dialysis or a kidney transplant.
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