Nephrotic syndrome

Description

Nephrotic syndrome is a kidney disorder that causes your body to pass the excess protein in the urine.

The nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in the kidneys that filter waste and excess water from the blood. The condition causes swelling, particularly of the feet and ankles, and increases the risk of other health problems.

Treatment for nephrotic syndrome includes the treatment of the condition you are doing and take drugs. The nephrotic syndrome may increase the risk of infections and the formation of blood clots. Your doctor may recommend medication and changes in diet to prevent complications.

Symptoms

The signs and symptoms of nephrotic syndrome include:

  • Swelling (edema), especially around your eyes and in your ankles and feet
  • Foamy urine, result of an excess of protein in the urine
  • The weight gain due to fluid retention
  • Fatigue
  • Loss of appetite

When to see a doctor

Make an appointment with your doctor if you have signs or symptoms that worry you.

Causes

The nephrotic syndrome is usually caused by damage to the clusters of small blood vessels (glomeruli) of the kidneys.

The glomeruli filter the blood as it passes through the kidneys, the separation from what your body needs of those who do not. Healthy glomeruli of the blood proteins (mainly albumin) — which is needed to maintain the proper amount of fluid in your body — that penetrate into the urine. When damaged, the glomeruli allow too much protein in the blood to leave your body, which leads to a nephrotic syndrome.

Many possible causes

Many diseases and conditions that can cause glomerular damage and lead to nephrotic syndrome, including:

  • Diabetic kidney disease. Diabetes can lead to kidney damage (diabetic nephropathy) that affects the glomeruli.
  • Minimal change disease. This is the most common cause of nephrotic syndrome in children. Minimal change disease of abnormal results of kidney function, but when the kidney tissue is examined under a microscope, it appears normal or nearly normal. The cause of the alteration of the function usually cannot be determined.
  • Focal segmental glomerulosclerosis. It is characterized by scarring of some of the glomeruli, this condition may be the result of another disease, a genetic defect or certain medicines or occur for no known reason.
  • Membranous nephropathy. This kidney disorder is the result of the thickening of the membranes within the glomeruli. The thickening is due to the deposits made by the immune system. It can be associated with other medical conditions, such as lupus, hepatitis B, malaria, and cancer, or it may occur for no known reason.
  • Systemic Lupus erythematosus. This chronic inflammatory disease that can lead to serious kidney damage.
  • Amyloidosis. This disorder occurs when amyloid proteins accumulate in their bodies. The accumulation of amyloid often damages the kidneys, the filtration system.

Risk factors

Factors that may increase the risk of nephrotic syndrome include:

  • Medical conditions that can damage your kidneys. Certain diseases and conditions increase your risk of developing nephrotic syndrome, such as diabetes, lupus, amyloidosis, reflux nephropathy and other kidney diseases.
  • Certain medications. Medications that can cause nephrotic syndrome include nonsteroidal anti-inflammatory drugs and medications used to fight infections.
  • Certain infections. Infections that increase the risk of nephrotic syndrome include HIV, hepatitis B, hepatitis C and malaria.

Complications

The possible complications of nephrotic syndrome include:

  • The blood clots. The inability of the glomeruli to filter the blood properly can lead to loss of proteins in the blood that helps to prevent the coagulation of the blood. This increases your risk of developing a blood clot in your veins.
  • High cholesterol in the blood, and elevated levels of triglycerides in the blood. When the level of the protein albumin in the blood drops, the liver does most of albumin. At the same time, the liver releases more cholesterol and triglycerides.
  • Poor nutrition. The loss of too much protein in the blood can result in malnutrition. This can lead to weight loss, which can be masked by edema. You can also have too few red blood cells (anemia), low blood protein levels and low levels of vitamin D.
  • The high blood pressure. The damage to your glomeruli and the result of the accumulation of excess fluid from the body can increase your blood pressure.
  • The acute kidney injury. If the kidneys lose their ability to filter the blood due to damage to the glomeruli, the debris can quickly build up in the blood. If this happens, you might need emergency dialysis — an artificial medium to remove excess fluids and waste from the blood — usually with an artificial kidney machine (dialyzer).
  • Chronic kidney disease. Nephrotic syndrome can cause your kidneys to lose their function over time. If your kidney function is low enough, you may need dialysis or a kidney transplant.
  • Infections. People with nephrotic syndrome have a higher risk of infections.

Nephrotic syndrome

Diagnosis

Tests and procedures used to diagnose nephrotic syndrome include:

  • Urine tests. A urine analysis may reveal abnormalities in the urine, such as large amounts of protein. You may be asked to collect urine samples of 24 hours.
  • Blood tests. A blood test may show low levels of the protein albumin and, often, the decreased levels of blood protein overall. The loss of albumin is often associated with an increase in blood cholesterol and triglycerides in the blood. The creatinine and urea nitrogen levels in the blood can also be measured to assess their overall kidney function.
  • The renal biopsy. Your doctor may recommend the removal of a small sample of kidney tissue for testing. During a kidney biopsy, a needle is inserted through the skin and into the kidney. The renal tissue is collected and sent to a laboratory for analysis.

Treatment

Treatment of nephrotic syndrome involves treatment of any medical condition that could be the cause of the nephrotic syndrome. Your doctor may also recommend medications and changes in your diet to help control their signs and symptoms, or to treat the complications of the nephrotic syndrome.

Medications may include:

  • Blood pressure medications.Medications called angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure and the amount of protein that is released in the urine. Medicines in this category include lisinopril (Prinivil, Qbrelis, Zestril), benazepril (Lotensin), captopril, and enalapril (Vasotec). Another group of medications that work in a similar way are called angiotensin II receptor blockers (arbs), and includes losartan (Cozaar) and valsartan (Diovan). Other medications, such as renin inhibitors, could also be used, in spite of the angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (arbs) are generally used in the first place.
  • Water pills (diuretics). These help to control swelling by increasing your kidneys output of fluid. Diuretic medications usually include furosemide (Lasix). Others include spironolactone (Aldactone, Carospir) and thiazides such as hydrochlorothiazide or metolazone (Zaroxolyn).
  • Cholesterol-lowering drugs.Statins can help reduce cholesterol levels. However, it is not clear whether the cholesterol-lowering medications can improve outcomes for people with nephrotic syndrome, such as preventing heart attacks or decreasing the risk of early death. Statins include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pravastatin (Pravachol), rosuvastatin (Crestor, Ezallor), and simvastatin (Zocor).
  • Blood thinners (anticoagulants). These can be prescribed to reduce the ability of your blood to clot, especially if you have had a blood clot. Anticoagulants include heparin, warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), apixaban (Eliquis) and rivaroxaban (Xarelto).
  • Immune system-suppressing drugs. Medications to control the immune system, such as corticosteroids, can decrease the inflammation that accompanies some of the conditions that can cause nephrotic syndrome. The medications include rituximab (Rituxan), cyclosporine, and cyclophosphamide.

Blood pressure medications. Medications called angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure and the amount of protein that is released in the urine. Medicines in this category include lisinopril (Prinivil, Qbrelis, Zestril), benazepril (Lotensin), captopril, and enalapril (Vasotec).

Another group of medications that work in a similar way are called angiotensin II receptor blockers (arbs), and includes losartan (Cozaar) and valsartan (Diovan). Other medications, such as renin inhibitors, could also be used, in spite of the angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (arbs) are generally used in the first place.

Cholesterol-lowering drugs. Statins can help reduce cholesterol levels. However, it is not clear whether the cholesterol-lowering medications can improve outcomes for people with nephrotic syndrome, such as preventing heart attacks or decreasing the risk of early death.

Statins include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pravastatin (Pravachol), rosuvastatin (Crestor, Ezallor), and simvastatin (Zocor).

Self-care

Changes to your diet may help with the nephrotic syndrome. Your doctor may refer you to a nutritionist, who might recommend that you do the following:

  • Choose lean sources of protein. Plant-based protein is useful in kidney disease.
  • Reduce the amount of fat and cholesterol in your diet to help control your cholesterol levels in the blood.
  • Eating a low-salt diet to help control swelling.
  • Reduce the amount of fluid in your diet.

Preparing for your appointment

Start by seeing your primary care physician. If your doctor suspects you or your child has a kidney problem, such as nephrotic syndrome, you may be referred to a doctor who specializes in the kidneys (nephrologist).

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as restrict your diet. Have a friend or family member, if possible, to help you remember the information that will be given.

Make a list of:

  • Your or your child's symptoms and when they began
  • Key personal information, including major stresses or recent life changes
  • All medications, vitamins or supplements that you or your child is taking, including dose
  • Questions to ask your doctor

For nephrotic syndrome, some questions are:

  • What is the most likely cause of my or my child's nephrotic syndrome?
  • What evidence do I or my child need?
  • It is this condition likely temporary?
  • What are the treatment options? And I recommend?
  • There are changes that I can do to my or my child's diet? May want to consult a dietitian help?
  • How can I best manage this condition with that of my or my child's other medical conditions?
  • Are there brochures or other printed material I can have? What sites do you recommend?

What to expect from your doctor

Your doctor may ask you questions, such as:

  • Did the symptoms come and go, or do you have all the time?
  • How severe are the symptoms?
  • Nothing seems to improve the symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Nephrotic syndrome