Nephrotic Syndrome : Causes, Symptoms & Treatment

What Is Nephrotic Syndrome?

Nephrotic syndrome is a kidney condition with several symptoms. It is caused by damaged glomeruli, the kidneys’ tiny filtering units. Most of the protein, for example, albumin, is leaked into the urine due to the malfunctioning of the kidneys. Protein loss can cause low blood protein, edema, and high cholesterol.

Nephrotic syndrome can appear at any age, but it mainly occurs in children. It can be either primary or secondary. Primary nephrotic syndrome is due to specific kidney diseases: minimal change disease, focal segmental glomerulosclerosis, or membranous nephropathy. Secondary nephrotic syndrome is due to systemic diseases. These include diabetes, lupus, and infections like hepatitis B and HIV.

Symptoms usually manifest in the form of severe swelling in the body parts, mainly the lower limbs, feet, and face, through fluid retention. Other symptoms include the existence of foam in the urine, dizziness, weight gain, and a decrease in urine flow.

Diagnosis is mainly based on urine tests showing high protein levels. Blood tests check kidney function. Sometimes, a kidney biopsy finds the cause. Early diagnosis and treatment are vital for managing nephrotic syndrome. They can reduce complications.

Nephrotic Syndrome Causes and Risk Factors

Nephrotic syndrome results from many different causes and conditions of kidney damage. The causes may be subdivided into two forms: primary or secondary.

Main Reasons:

1. Minimal Change Disease (MCD): MCD is the most common cause of nephrotic syndrome in children. There is relatively little histological damage to the glomeruli. In most patients, the cause is unknown. The disease may be due to a weak immune system.
2. FSGS: It is that disease in which scarring is seen in some regions of the glomeruli. The disease is either of the primary or secondary type related to obesity, or hypertension.
3. Membranous Nephropathy: In most cases, infections or drugs cause immune deposits in the glomeruli. They lead to inflammation.

Secondary Causes:

1. Diabetes Mellitus: Diabetic nephropathy is due to poorly controlled diabetes. It causes progressive kidney damage.
2. SLE: This disease may cause nephrotic syndrome brought about by inflammation in the kidney.
3. Infection: Nephrotic syndrome can be caused by viral infections, such as hepatitis B, hepatitis C, and HIV.
4. Medications: Some drugs, like NSAIDs and some antibiotics, can harm the kidneys.
5. Obesity and hypertension may lead to nephrotic syndrome. They can harm the kidneys.

Risk Factors:

There are predisposing factors that cause one to develop nephrotic syndrome. These factors include age, gender, and a family history of kidney disease. It is more common in children and more prevalent in males. We must find and address the underlying causes of nephrotic syndrome early. This is key to preventing and treating the disease.

Also Read : Foods To Avoid With Kidney Disease

Nephrotic Syndrome Symptoms

The symptoms of nephrotic syndrome vary with the intensity and cause. However, there are often hallmark signs that can be included:

1. Swelling: Swelling is probably one of the most common symptoms. They occur mainly on the legs, ankles, and even feet and under the eyes. It is a condition caused by fluid retention within the body due to its low protein levels in the blood.
2. Frothy Urine: More proteins in the urine cause frothing or foaming of the same. This is the greatest predictor of nephrotic syndrome and normally leads to further studies.
3. Weight gain: Fluid retention causes weight gain very rapidly. One can notice how clothes are getting too tight, or the changes in the body measurements are occurring.
4. Fatigue: Usually, the patients come with a feeling of fatigue or malaise due to the body’s response to loss of protein and fluid retention.
5. Oliguric output: This can be depicted as low urine production especially when fluid retention is seen.
6. High Cholesterol Levels: Dehydration from protein loss raises cholesterol and triglyceride levels. This does not necessarily happen overnight, but in the long run, it will surely impact future health.
7. Abdominal Pain: A patient might have some abdominal pain or may be tender in the abdomen because of ascites which is the accumulation of fluid in the belly.

These symptoms affect the person’s quality of life very much. Therefore, persons having this disorder need to consult a medical practitioner at the earliest. Early diagnosis and treatment may manage symptoms and avoid complications of nephrotic syndrome.

Nephrotic Syndrome Complications

Many associated complications can affect both the kidney function and the general health of the patient with nephrotic syndrome. The complications will help in determining some early interventions and managements:

1. Chronic Kidney Disease: It is the most severe long-term consequence of nephrotic syndrome which results in progressive kidney damage. It can be chronic and lead to end stage disease, requiring dialysis or kidney transplant. The kidney function may deteriorate with time due to the long term protein loss in urine.
2. Infections: Immunoglobulins are proteins that help your immune system fight diseases and infections. When you lose those proteins in urine, you lose immunoglobulins, you’re at a greater risk of general infections that affect different body system.

This infection risk often shows itself as peritonitis, pneumonia, and severe skin infections.

3. Blood Clots: A deficiency in proteins responsible for the clotting of blood may lead to thromboembolism. These are deep vein thrombosis and pulmonary embolism. It is possible to develop a serious problem if timely treatment is not received.
4. Hypercholesterolemia: This refers to the condition where cholesterol levels are elevated. This disorder is characterized by high levels of cholesterol as well as triglycerides. It poses a great risk to develop cardiovascular diseases, heart attack, and stroke.
5. Edema and Fluid Retention: Swelling on a large scale can be also very painful and will restrict movement. In the lungs fluid may accumulate, causing breathing problems (pulmonary edema). It also can lodge in the abdomen (ascites), resulting to pain and discomfort.
6. Malnutrition: Loss of proteins results in malnutrition due to the fact that the body fails to retain a sufficient amount of protein. This therefore causes a wasting of muscles and an impaired immunity system.

Managing these complications also focuses on close monitoring and lifestyle changes. It is additionally essential to have medical treatments to mitigate their effects on health and quality of life.

Nephrotic Syndrome Diagnosis

Diagnosis of nephrotic syndrome is usually based on medical history, physical examination, and laboratory tests. Confirmation of symptomatology and rule out of possible etiological factors can usually be stipulated. The diagnostic approach includes:

1. Medical History and Physical Examination: The provider takes a detailed medical history from the patient. He or she notes any swelling, alteration in urinary output, and other conditions that developed acutely. The physical examination is additive and done along with signs of edema and general well-being.
2. Urinalysis: This is a thorough urinalysis performed to find the protein in urine. This situation is referred to as proteinuria, one of the characteristic symptoms of nephrotic syndrome. It could also contain red and white blood cells as well as casts.

3. 24-hour Urine Collection: This is a type of test in the quantification of the protein excretion rate produced by the kidneys during 24 hours. More than 3.5 g per day defines a case of nephrotic syndrome.

4. Blood Tests: This is done to assess renal function, with the inclusion of the estimations of creatinine and blood urea nitrogen. Serum protein levels, albumin, and lipid profile are also included. Low serum albumin and hypercholesterolemia will only add credence to this diagnosis.
5. Imaging Studies: Ultrasound or other tests are needed to see the kidneys and their details, or to rule out other conditions.
6. Kidney Biopsy: A kidney biopsy would be done if the cause of the nephrotic syndrome is unknown. 

Early detection will help better in handling the condition as well as averting major complications.

Nephrotic Syndrome Treatment

Treatment aims to control symptoms, fix causes, and prevent complications. The type of nephrotic syndrome and the level of symptoms also affect the type of treatment. Important approaches to treatment include:

1. Medications:

• Corticosteroids: It is usually the first drug of choice especially in cases of primary nephrotic syndrome. These drugs reduce inflammation and suppress the immunity that reduces the excretion of proteins in the urine.
• Immunosuppressants: Prescription immunosuppressants are employed. Once steroids are not responsive and major damage has been caused to the kidney then these drugs are administered to minimize the effect of an immune response.
• Diuretics: Diuretics can be offered to decrease edema and, consequently fluid retention and swelling in the affected part.

2. Dietary Changes: For edema, a diet low in sodium may be helpful. Nutrition requirement is maintained by sufficient protein intake. Diet is low in saturated fats as per clinical scenarios to manage cholesterol levels.
3. Cholesterol-Lowering Drugs: Any lipid-lowering drug lowers heart disease risks by controlling cholesterol.
4. Manage blood pressure with medication, if needed. It must not damage the kidneys.
5. Follow-ups: We need follow-up visits and tests to check the kidneys, protein levels, and overall health. Treatment may have to be altered based on these observations.
6. Primary Diseases Treat nephrotic syndrome along with the primary disease, like diabetes or lupus.

The goal of treatment is to help patients with nephrotic syndrome. We aim to reduce symptoms, improve their quality of life, and prevent complications. This will help them live healthier.

Nephritic Syndrome Vs Nephrotic Syndrome

Nephritic syndrome is caused by damage to the kidneys’ filtering units. It is different from nephrotic syndrome.

1. Definition:

Nephritic syndrome: Inflammation of the glomeruli causes hematuria, or blood in the urine. It often has less proteinuria than nephrotic syndrome, along with hypertension and oliguria.

Nephrotic Syndrome: It is a condition marked by a huge loss of protein in the urine. Symptoms include: heavy proteinuria over 3.5 grams per day, low albumin, severe swelling, and high lipids.

2. Causes:

Nephritic Syndrome: The most common causes are post-infectious glomerulonephritis (usually after strep infections), IgA nephropathy, and lupus nephritis. It is typically associated with immune-mediated diseases.

Nephrotic Syndrome: It may be primary, such as minimal change disease and focal segmental glomerulosclerosis. Or, it may be secondary due to diabetes, amyloidosis, infections, and more. Primarily, it is due to damage to the glomerular filtration barrier.

3. Symptoms:

Nephritic Syndrome: It causes hematuria and proteinuria. It’s less severe than nephrotic syndrome. It also has edema, hypertension, and possible renal failure.

Nephrotic Syndrome: Presentations include major edema, proteinuria, hypoalbuminemia, and hyperlipidemia. The urine is frothy due to the excess protein.

4. Diagnosis:

• Both are diagnosed by urinalysis, blood tests, and sometimes kidney biopsy. Nephritic syndrome may cause red blood cells and casts in urine. In nephrotic syndrome, high proteinuria and low serum albumin levels diagnose it.

5. Treatment:

For nephritic syndrome, treat hypertension and the cause of any infection or immune disease. Nephrotic syndrome is largely treated with corticosteroids and immunosuppressants to reduce protein loss.

We must understand the differences between these syndromes. It’s essential for their diagnosis and management. Different treatments are needed for each.

Nephrotic Syndrome Diet Plan

A well-planned diet is one important aspect of the effective management of the nephrotic syndrome. So, we would stress relieving symptoms, reducing fluid build-up, and keeping good health. Here is an example diet plan:

General Nutrition Standards:

• Low Sodium: Decrease sodium levels to minimize fluid accumulation and swelling. This would be below 2,000 mg of sodium per day.
• Adequate Protein In advanced kidney disease, one might need to restrict the amount of protein. Most patients with nephrotic syndrome will, however, need enough protein intake to support their muscle mass. Sources of high-quality protein are lean meats, fish, eggs, and dairy.
• Healthy fats– healthy fats should be included from such sources as avocado, nuts, seeds, and olive oil but must be trans and saturated-free.
• High fiber food: Increase fiber by fruits, vegetables, whole grains, and legumes for good digestive functions while lowering cholesterol levels.

Sample Daily Meal Plan:

Breakfast

• Oatmeal with fresh fruits and nuts sprinkled on top
• glass of low-fat milk or yogurt

Mid-Morning Snack:

• Thinly sliced apple or banana with a spoonful of almond butter

Lunch:

• Side: Quinoa with grilled chicken or fish and steamed broccoli.
• Mixed green salad dressed in olive oil

Mid-Day Snack:

• Stick carrot or cucumber with hummus

Dinner

• Baked salmon with sweet potatoes and green beans
• A small portion of brown rice or whole-grain bread

Evening Snack:

• A serving of berries or a chunk of dark chocolate in measure

Hydration

• Hydration is encouraged. But, restrict fluids if a doctor advises it, especially if the patient has significant swelling.
• Always seek the opinion of a healthcare provider or dietitian for the best diet advice for your health needs.

 Also Read : Diet Chart For Kidney Patients

Nephrotic Syndrome : When to See a Doctor

The important thing about effectively managing nephrotic syndrome is knowing when to report to a healthcare provider. Report to a provider if you experience any of the following signs or situations:

1. Swelling: Noticeable or lasting swelling in the legs, ankles, or around the eyes (edema). This is especially important if it interferes with daily activities or is uncomfortable.
2. Alteration in Urination: If you suddenly have a lot or little to urinate, or if the urine is frothy or colored, you need to see a doctor.
3. High Blood Pressure If your blood pressure is consistently above 130/80 mm Hg, see a doctor. It can cause complications.
4. Fatigue and Weakness: Unexplained fatigue and general weakness may signal worsening or complications.
5. New Infections: Whenever you notice infection symptoms like fever, chills, or persistent coughing, particularly during the time after you have been diagnosed with nephrotic syndrome, see your doctor right away.
6. Dietary Changes: Consult a dietitian or physician if you are unclear about changing your diet to improve symptoms.
7. Side effects of drugs If you have side effects from nephrotic syndrome drugs, such as steroids or immunosuppressants, seek other treatments. Talk to your doctor about changing your treatment.

It may also prevent complications of the disease and enhance the management of the syndrome as a whole, hence enhancing the quality of life.

Nephrotic Syndrome : Conclusion

Nephrotic syndrome is an overstrained kidney disease. It causes high protein in the urine. Patients show signs of edema, hypoalbuminemia, and hyperlipidemia. The disease could either be primary or secondary to conditions such as diabetes and lupus; adults as well as children are equally exposed. Early diagnosis and treatment are crucial. Prompt intervention can improve symptoms and slow kidney damage.

Generally, treatment is multimodal and may involve prescription drugs, dietary changes, and lifestyle changes, depending on the individual’s need.

Thus, managing nephrotic and nephritic syndrome requires knowing the difference. It also requires a proper diet and regular medical checkups. A patient with nephrotic syndrome should watch for complications. These include severe swelling, infections, and high blood pressure. They require prompt medical attention.

References 

1. Nephrotic syndrome treatments, causes & symptoms. American Kidney Fund [Internet]. https://www.kidneyfund.org/all-about-kidneys/other-kidney-problems/nephrotic-syndrome-treatments-causes-symptoms. Accessed Nov. 20, 2024.

2. Nephrotic syndrome in adults. National Kidney Federation[Internet]. https://www.kidney.org.uk/nephrotic-syndrome-in-adults . Accessed Nov. 22, 2024.
3. Nephrotic Syndrome. National Kidney Foundation[Internet]. https://www.kidney.org/kidney-topics/nephrotic-syndrome. Accessed Nov. 23, 2024.
4. Nephrotic syndrome.  Kidney Research UK[Internet]. https://www.kidneyresearchuk.org/conditions-symptoms/nephrotic-syndrome/. Accessed Nov. 25, 2024.
5. Nephrotic Syndrome. Penn Medicine[Internet]. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/nephrotic-syndrome. Accessed Nov. 25, 2024.