Nephrotic Syndrome: Protecting Your Kidneys

What is Nephrotic Syndrome?

A kidney disease called nephrotic syndrome makes the body excrete an excessive amount of protein in urine. The destruction to the small blood artery clusters in the kidneys, which remove waste and extra water from the blood, is typically what causes nephrotic syndrome. In addition to increasing the risk of other health issues, the disorder produces swelling, especially in the ankles and feet.

Kidney function

Nephrotic syndrome in children

While nephrotic syndrome may impact individuals at any age, children between the ages of one and six are typically the ones who receive the initial diagnosis. Thus, Steroid medication can frequently be used to control the symptoms of nephrotic syndromes.

The majority of kids with nephrotic syndrome react effectively to steroids and don’t have a kidney failure risk. However, a small percentage of kids have congenital nephrotic syndrome, which typically results in worse outcomes. They might eventually require a kidney transplant due to kidney failure.

Causes

The majority of children with this syndrome exhibit ‘minimal change disease,’ meaning that, when their kidney tissue is examined under a microscope, it appears normal or nearly normal.

However, if the tissue sample is examined under a very strong electron microscope, variations to it can be observed. Thus, it is uncertain what causes minimal change in disease.

It can occasionally be brought on by a renal issue or another illness, such as:

  • Glomerulosclerosis: a condition in which the kidney’s inside gets scarred
  • Glomerulonephritis, or kidney inflammation
  • An infection, such as hepatitis or HIV
  • Lupus
  • Diabetes
  • Sickle cell anemia
  • Very rarely, some cancers, like lymphoma, multiple myeloma, or leukemia
Nephrotic Syndrome in children
Onset mechanism of childhood nephrotic syndrome

Causes

Damage to the kidneys’ glomeruli, which are collections of small blood arteries, is typically the cause of nephrotic syndrome. As blood flows through your kidneys, the glomeruli filter it, removing substances that your body doesn’t require. Thus, maintaining the proper level of fluid in your body requires blood protein, primarily albumin, which is prevented from leaking into the urine by healthy glomeruli. Also, damage to the glomeruli causes excessive blood protein to leave the body, which results in nephrotic syndrome.

Causes of hyperlipidemia

Hyperlipidemia in nephrotic syndrome is closely linked to the loss of protein in the urine. As the kidneys fail to retain essential proteins, such as albumin, the liver steps up its production, which inadvertently raises the levels of lipids like cholesterol and triglycerides in the bloodstream. Both the faster hepatic production of lipids and their delayed rate of excretion from the bloodstream lead to nephrotic hyperlipidemia. Thus, overproduction and release of lipids from the liver result in hyperlipidemia, further complicating the condition and potentially leading to other health complications like heart disease.

Other causes

  • Diabetic Kidney Disease: Diabetes can cause kidney damage (diabetic nephropathy), affecting the glomeruli.
  • Minimal Change Disease: Common in children, it causes nephrotic syndrome with abnormal kidney function, though tissue appears normal under a microscope.
  • Focal Segmental Glomerulosclerosis: This condition involves scarring of some glomeruli, possibly due to disease, genetics, medications, or unknown causes.
  • Membranous Nephropathy: Characterized by thickened glomerular membranes from immune deposits, associated with conditions like lupus, hepatitis B, or cancer, or sometimes unknown causes.
  • Systemic Lupus Erythematosus: A chronic inflammatory disease that can severely damage the kidneys.
  • Amyloidosis: This occurs when amyloid proteins build up in organs, damaging the kidneys’ filtering system.

Symptoms

  • Severe swelling (edema)
  • Foamy urine
  • Weight gain due to fluid retention
  • Fatigue
  • Loss of appetite

Nephrotic syndrome diagnosis

Urine Tests

  • A doctor can use a urine sample to identify urinary anomalies, such as elevated protein levels.
  • Doctors may require you to provide urine samples over a 24-hour period.

Blood examinations

  • It can detect low levels of the protein albumin as well as reduced amounts of total blood protein,
  • Doctors can identify high levels of cholesterol and triglycerides. They may also examine creatinine and blood urea nitrogen levels to evaluate general kidney function.

Kidney biopsy

  • The doctor may advise taking a little kidney tissue sample for analysis. During a kidney biopsy, a doctor pushes a needle through your skin and into your kidney.
  • Thus, after gathering, the doctor will send the kidney tissue to a lab for analysis.

Treatment of nephrotic syndrome 

Medications include

Blood pressure medications

  • Angiotensin-Converting Enzyme (ACE) Inhibitors: Lower blood pressure and reduce urine protein; examples include lisinopril, benazepril, captopril, and enalapril.
  • Angiotensin II receptor (ARB) blockers: Similar effects; examples include losartan and valsartan.
  • Renin Inhibitors: May be used, but ACE inhibitors and ARBs are preferred.

Diuretics

  • Water Pills: Increase fluid output to control swelling; includes furosemide, spironolactone, and thiazides like hydrochlorothiazide.

Cholesterol-Reducing Medications

  • Statins: Lower cholesterol, though their impact on nephrotic syndrome outcomes is uncertain; includes atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin.

Blood Thinners

  • Anticoagulants: Reduce blood clotting; examples include heparin, warfarin, dabigatran, apixaban, and rivaroxaban.

Immune System-Suppressing Medicines

  • Corticosteroids and Others: Reduce inflammation; includes rituximab, cyclosporine, and cyclophosphamide.

Possible Complications of Nephrotic Syndrome:

  • Blood Clots: The risk of blood clot formation in veins is increased by the loss of blood proteins.
  • High Cholesterol and Triglycerides: Reduced albumin levels lead to increased production of cholesterol and triglycerides by the liver.
  • Poor Nutrition: In addition, Protein loss can cause malnutrition, anemia, and vitamin D deficiency.
  • Hypertension: Damage to the kidneys and accumulation of fluid can cause hypertension.
  • Acute Kidney Injury (AKI): Also, kidney damage may lead to a rapid buildup of waste, potentially requiring emergency dialysis.
  • Chronic Kidney Disease: Long-term kidney damage may necessitate dialysis or a transplant.
  • Infections: Increased risk due to compromised immune function.

Dietary advice for nephrotic syndrome

For those with nephrotic syndrome, dietary modifications may help. The doctor may suggest an appointment to see a nutritionist, who may suggest the following actions:

  • Select lean protein sources. Protein derived from plants is beneficial in kidney function.
  • To assist in managing your blood cholesterol levels, cut back on the fat and cholesterol in the food you consume.
  • Reduce your intake of salt to help manage swelling.
  • Cut back on the liquids in the diet.

Sources

Written by Snegkha S

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