Nephrotic syndrome

Nephrotic syndrome is a kidney disorder characterized by a group of symptoms that result from damage to the glomeruli, which are tiny blood vessels in the kidneys responsible for filtering waste and excess fluids from the blood. Nephrotic syndrome can affect both children and adults and is typically characterized by the following key features:

Proteinuria: One of the hallmark signs of nephrotic syndrome is the excessive loss of protein in the urine. Normally, only a small amount of protein is excreted in the urine, but in nephrotic syndrome, the damaged glomeruli allow large amounts of protein, particularly albumin, to escape into the urine. This leads to a condition called “proteinuria.”
Hypoalbuminemia: Due to the loss of albumin in the urine, the blood’s levels of this protein become abnormally low. This can result in fluid retention and edema (swelling) in various parts of the body, typically seen as swelling around the eyes, ankles, and legs.
Hyperlipidemia: Individuals with nephrotic syndrome often have elevated levels of cholesterol and triglycerides in the blood, which can increase the risk of cardiovascular problems.
Edema: Edema is a common symptom of nephrotic syndrome, and it usually affects the lower extremities (legs and ankles) but can also involve the face and abdomen. This swelling occurs due to the accumulation of fluid in body tissues.
Hypercoagulability: Nephrotic syndrome can increase the risk of blood clots (thrombosis) because of changes in blood composition and the release of clotting factors from the liver.

Nephrotic syndrome can have various underlying causes, including:

Minimal Change Disease (MCD): This is the most common cause of nephrotic syndrome in children. In MCD, kidney biopsies typically appear normal under a microscope, but there is significant proteinuria.
Focal Segmental Glomerulosclerosis (FSGS): FSGS involves scarring in some glomeruli, and it can lead to nephrotic syndrome. This condition can have a genetic or non-genetic cause.
Membranous Nephropathy: Membranous nephropathy is characterized by thickening and inflammation of the glomerular membrane, which leads to proteinuria.
Diabetic Nephropathy: In individuals with diabetes, kidney damage can progress to nephrotic syndrome, especially in advanced stages of the disease.
Systemic Lupus Erythematosus (SLE): Lupus, an autoimmune disease, can affect the kidneys and cause nephrotic syndrome in some cases.

Treatment for nephrotic syndrome aims to reduce proteinuria, control edema, and address the underlying cause if possible. Common treatment approaches include:

Corticosteroids: Medications like prednisone are often used to suppress the immune response and reduce proteinuria in cases like MCD.
Immunosuppressive Therapy: For some causes of nephrotic syndrome, such as FSGS and membranous nephropathy, immunosuppressive drugs may be prescribed.
Diuretics: These drugs help to remove excess fluid from the body and reduce edema.
Dietary Changes: Reducing salt and saturated fat intake can help manage fluid retention and hyperlipidemia.
Management of Underlying Conditions: In cases where nephrotic syndrome is secondary to an underlying condition like diabetes or lupus, managing that condition is essential.

It’s crucial for individuals with nephrotic syndrome to work closely with healthcare providers, including nephrologists, to determine the underlying cause and develop a personalized treatment plan. With appropriate medical management, many people with nephrotic syndrome can achieve remission and maintain good kidney function. However, some cases may be more challenging to treat, and long-term monitoring is often necessary.