The nephrotic syndrome. NEPHROTIC SYNDROME OVERVIEWThe term . More detailed information is available by subscription. This damage allows proteins in the blood (such as albumin) to leak into the urine, causing increased excretion of protein (proteinuria) (see . Eventually, blood levels of albumin become reduced. Accompanying abnormalities of kidney function lead to accumulation of fluid in the tissues (edema). How are glomeruli damaged? In some cases, damage is confined to the kidneys alone. In other cases, organs other than the kidney are also affected (such as in diabetes mellitus or systemic lupus erythematosus). People with minimal change disease have normal or very mild abnormalities of the glomeruli. FSGS causes collapse and scarring of some glomeruli. The cause of primary FSGS is unknown, although some cases (usually in children or young adults) are the result of a genetic defect, an infection, or a toxic response to a drug. Membranous nephropathy — Membranous nephropathy is a condition in which the walls of the glomerular blood vessels become thickened from the accumulation of protein deposits, causing increased . Kidney disease amongst diabetics is commonly called diabetic nephropathy. Statistically, around 40% of people with diabetes develop nephropathy but it is possible. Treating Glomerulonephritis and Nephrotic Syndrome. If you have nephritis that was caused by an infection, your doctor may prescribe antibiotics. Home > HUS Information > What is Hemolytic Uremic Syndrome (HUS), and Why is it so Deadly? What is Hemolytic Uremic Syndrome (HUS), and Why is it so Deadly? Some patients with more advanced disease can develop the nephrotic syndrome. Lupus — Lupus is a disease that can affect multiple organs of the body, including the kidney. Nephrotic syndrome is common in people with severe lupus. Kidney failure may develop in some people. Increased excretion of protein may lead to . Swelling (edema) can also occur in the feet or ankles after sitting or standing for any period of time. Weight gain can occur rapidly. Uncommonly, weight loss can occur in people who are losing large quantities of protein in the urine. This may be due to malnutrition or an underlying condition, such as poorly controlled diabetes mellitus, a chronic viral infection, or cancer. Kidney failure — Some people with nephrotic syndrome have a gradual decline in kidney function, which causes no symptoms in the early stages. However, as kidney function continues to worsen, symptoms of kidney failure can develop, including shortness of breath, weakness and easy fatigability (from anemia) and loss of appetite. Blood lipids — The concentration of lipids (cholesterol and/or triglycerides) can become greatly elevated in nephrotic syndrome. If persistent, this may increase the risk of coronary artery disease. Blood clots — People with nephrotic syndrome are at an increased risk of blood clots in the veins or arteries. Clots in the veins can travel to the lungs. This can be dangerous, or even fatal. In addition, almost all patients are given an angiotensin- converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB), which lower blood pressure, prevent worsening of kidney disease, and reduce the amount of protein excreted in the urine. Diabetes mellitus — The optimal treatment for diabetic kidney disease is not well understood, although the best approach likely includes intensive management of blood sugar levels, cholesterol, and blood pressure. Lupus — People with lupus who have nephrotic syndrome or evidence of worsening kidney function can be treated with steroids and other medications that suppress the immune system. Most people respond well to such a regimen. Minimal change disease — People with minimal change disease almost always respond initially to treatment with glucocorticoids (steroids). However, relapses are common, and additional treatments are often required. Secondary FSGS is treated primarily with ACE inhibitors or ARBs. In many people, a period of . During this time, an ACE inhibitor or ARB is recommended and it is important to keep blood pressure and cholesterol levels controlled. Additional treatment, including medications that suppress the immune system, may be needed if membranous nephropathy progresses. Without immunosuppressive treatment, approximately 1. Gain 2 pounds per week; Gain 1.5 pounds per week; Gain 1 pound per week; Gain 0.5 pound per week; Maintain my current weight; Lose 0.5 pound per week. You know the importance of good nutrition and exercise, but how do you feed a picky eater or encourage a child who hates sports to play outside? The term nephrotic syndrome refers to a group of symptoms and laboratory findings that may occur in people with certain kinds of kidney (renal) disease:High levels of. As a result, most people with mild symptoms are advised to delay immunosuppressive treatment until/unless symptoms worsen. Edema and ascites often improve in people who follow a low- sodium diet and take a . If nephrotic syndrome persists, treatment is needed to lower blood cholesterol. Most people are initially treated with a cholesterol- lowering medication called a statin. Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below. Patient level information — Up. To. Date offers two types of patient education materials. Start studying bstrandable NCLEX OB/Peds 3 of 3. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Nephrotic syndrome is a disorder of the glomeruli (clusters of microscopic blood vessels in the kidneys that have small pores through which blood is filtered) in. Nephrotic syndrome is a group of symptoms that, together, show that your kidneys are not working as well as they should. These symptoms include. View the latest health news and explore articles on fitness, diet, nutrition, parenting, relationships, medicine, diseases and healthy living at CNN Health. The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy- to- read materials. Patient education: Chronic kidney disease (The Basics)Patient education: Lupus and kidney disease (The Basics)Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in- depth information and are comfortable with some medical jargon. Patient education: Protein in the urine (proteinuria) (Beyond the Basics)Patient education: Diabetes mellitus type 1: Overview (Beyond the Basics)Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics)Patient education: Systemic lupus erythematosus (SLE) (Beyond the Basics)Patient education: Edema (swelling) (Beyond the Basics)Patient education: Renal (kidney) biopsy (Beyond the Basics)Patient education: Low- sodium diet (Beyond the Basics)Patient education: High cholesterol and lipids (hyperlipidemia) (Beyond the Basics)Patient education: Warfarin (Coumadin) (Beyond the Basics)Professional level information — Professional level articles are designed to keep doctors and other health professionals up- to- date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading. Acute kidney injury (AKI) in minimal change disease and other forms of nephrotic syndrome. Causes and diagnosis of membranous nephropathy. Diagnostic approach to the patient with subacute kidney injury in an outpatient setting. Differential diagnosis and evaluation of glomerular disease. Assessment of urinary protein excretion and evaluation of isolated non- nephrotic proteinuria in adults. Lipid abnormalities in nephrotic syndrome. Pathophysiology and treatment of edema in patients with the nephrotic syndrome. Overview of heavy proteinuria and the nephrotic syndrome. Renal vein thrombosis and hypercoagulable state in nephrotic syndrome. Urinalysis in the diagnosis of kidney disease. Etiology, clinical features, and diagnosis of minimal change disease in adults. Treatment of minimal change disease in adults. Treatment of idiopathic membranous nephropathy. The following organizations also provide reliable health information. Our peer review process typically takes one to six weeks depending on the issue. Nephrotic syndrome in children - NHS Choices Nephrotic syndrome is a condition that causes the kidneys to leak large amounts of protein into the urine. This can lead to a range of problems, including swelling of body tissues and a greater chance of catching infections. Although nephrotic syndrome can affect people of any age, it's usually first diagnosed in children aged between two and five years old. It affects more boys than girls. Around 1 in every 5. It tends to be more common in families with a history of allergies or those of an Asian background, although it's unclear why. The symptoms of nephrotic syndrome can usually be controlled with steroid medication. Most children with nephrotic syndrome respond well to steroids and aren't at risk of kidney failure. However, a small number of children have congenital (inherited) nephrotic syndrome and usually do less well. They may eventually have kidney failure and need a kidney transplant. What problems can it cause? Most children with nephrotic syndrome have times when their symptoms are under control (remission), followed by times when symptoms return (relapses). In most cases, relapses become less frequent as they get older and often stop by their late teens. Some of the main symptoms associated with nephrotic syndrome include: swelling – the low level of protein in the blood reduces the flow of water from body tissues back into the blood vessels, leading to swelling (oedema). Swelling is usually first noticed around the eyes, then around the lower legs and rest of the body. When these are lost, children are much more likely to get infections. Some children with nephrotic syndrome may also pass less urine than usual during relapses. This can increase their risk of potentially serious blood clots. During a relapse, the blood also becomes more concentrated, which can lead to clotting. Causes of nephrotic syndrome. Most children with nephrotic syndrome have . This means that their kidneys appear normal or nearly normal if a tissue sample is studied under a microscope. The cause of minimal change disease is unknown. Nephrotic syndrome can sometimes occur as a result of a kidney problem or another condition, such as: These problems tend to be more common in adults with nephrotic syndrome. Diagnosing nephrotic syndrome. Nephrotic syndrome can usually be diagnosed after dipping a dipstick into a urine sample. If there are large amounts of protein in a person's urine, there will be a colour change on the stick. A blood test showing a low level of a protein called albumin will confirm the diagnosis. In some cases, when the initial treatment doesn't work, your child may need a kidney biopsy. This is when a very small sample of kidney tissue is removed using a needle so it can be studied under a microscope. Managing nephrotic syndrome The main treatment for nephrotic syndrome is steroids, but additional treatments may also be used if a child develops significant side effects. Most children have relapses until their late teens and need to take steroids when these occur. Your child may be referred to a childhood kidney specialist (paediatric nephrologist) for tests and specialist treatment. Steroids. Children diagnosed with nephrotic syndrome for the first time are normally prescribed at least a four- week course of the steroid medicine prednisolone, followed by a smaller dose every other day for four more weeks. This stops protein leaking from your child's kidneys into their urine. When prednisolone is prescribed for short periods, there's usually no serious or long- lasting side effects, although some children may experience: increased appetite weight gain red cheeks mood changes Most children respond well to treatment with prednisolone, with the protein often disappearing from their urine and the swelling going down within a few weeks. This period is known as remission. Diuretics. Diuretics, or . They work by increasing the amount of urine produced. Penicillin. Penicillin is an antibiotic, and may be prescribed during relapses to reduce the chances of an infection. Dietary changes. You may be advised to reduce the amount of salt in your child's diet to prevent further water retention and oedema. This means avoiding processed foods and not adding salt to what you eat. Get tips on how to cut down on salt. Vaccinations. Children with nephrotic syndrome are advised to have the pneumococcal vaccine. Some children may also be recommended the varicella (chickenpox) vaccination between relapses. Live vaccines, such as MMR, chickenpox and BCG, shouldn't be given while your child is taking medication to control their symptoms. Additional medication. Other medications may be used alongside or in place of steroids if your child's remission can't be maintained with steroids or they experience significant side effects. Additional medications that may be used include: levamisole cyclophosphamide ciclosporin tacrolimus mycophenolate rituximab Albumin infusions. Most of the protein lost in nephrotic syndrome is a type called albumin. If your child's symptoms are severe, they may be admitted to hospital to receive albumin infusions. Albumin is slowly added to the blood over a few hours through a thin plastic tube called a cannula, which is inserted into one of the veins in their arm. Caring for your child at home. If your child has been diagnosed with nephrotic syndrome, you'll need to monitor their condition on a daily basis to check for signs of relapses. You'll need to use a dipstick to test your child's urine for protein the first time they urinate each day. The results of a dipstick test are recorded as either: negative – 0mg of proteinuria per decilitre of urine (mg/d. L) trace – 1. 5- 3. L 1+ – 3. 0- 1. 00mg/d. L 2+ – 1. 00- 3. 00mg/d. L 3+ – 3. 00/1,0. L 4+ – over 1,0. 00mg/d. L The result for each day needs to be written down in a diary for your doctor or specialist nurse to review during your outpatient appointments. You should also note down the dose of any medication they're taking and any other comments, such as whether your child is feeling unwell. If the dipstick shows 3+ or more of protein in the urine for three days in a row, this means your child is having a relapse. If this happens, you either need to follow the advice given about starting steroids or contact your doctor. You should seek immediate medical advice if: your child has come into contact with someone who has chickenpox or measles and your doctor has told you that your child is not immune to these illnesses your child is unwell or has a fever your child has diarrhoea and is vomiting Congenital nephrotic syndrome. Congenital nephrotic syndrome is usually caused by an inherited faulty gene. For the condition to be passed on to a child, both parents must have a healthy copy of the gene and a faulty one. This means they don't have nephrotic syndrome themselves, but there's a one in four chance that any children they have will develop the condition. Treating congenital nephrotic syndrome. If your child has congenital nephrotic syndrome, they'll need frequent albumin infusions to help them grow and develop normally. This often requires a stay in hospital. Sometimes parents can be trained to administer the treatment at home. Your child will be regularly reviewed at a clinic, where their blood pressure, growth, weight, kidney function and bone health will be monitored. It can be difficult for parents to decide which option is best, so you should talk to your doctor about the pros and cons of hospital- based and home- based treatment. Dialysis and kidney transplants. In some cases, your doctor may recommend surgery to remove one or both of your child's kidneys. This will stop proteins being lost in your child's urine and reduce their risk of potentially serious problems, such as blood clots. This means they'll be dependent on dialysis, where a machine replicates kidney function, from an early age until they can receive a kidney transplant. A person only needs one kidney to survive, so a living person can donate a kidney. Ideally, this should be a close relative. Read more about kidney transplants. Information about your child. If your child has congenital nephrotic syndrome, your clinical team will pass information about him or her on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the NCARDRS register. Page last reviewed: 2. Next review due: 0.
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