Nephrotic syndrome can occur when kidney filtering units are damaged. This damage allows large amounts of protein normally retained in the blood to leak into the urine, reducing the amount of protein in your blood. Because protein in the blood helps keep fluid in the bloodstream, some of this fluid leaks from the bloodstream into your tissues, causing swelling called edema. You can find more information below.

What is nephrotic syndrome?

Nephrotic syndrome is a kidney disease that causes high levels of protein in your urine when you don’t have enough protein in your blood. This syndrome is usually caused by damage to the clusters of tiny blood vessels in your kidneys that filter waste and excess water from your blood. This causes swelling, especially in your feet and ankles, and increases the risk of other health problems.

Treatment for nephrotic syndrome includes treating the condition causing it and taking medication. This syndrome can increase your risk of infections and blood clots. Your doctor may recommend medications and dietary changes to prevent complications.

What causes nephrotic syndrome?

Nephrotic syndrome is usually caused by clusters of small blood vessels (glomeruli) in your kidneys. The glomeruli filter your blood as it passes through your kidneys, separating what your body needs from those that don’t. Healthy glomeruli prevent blood protein (mainly albumin) from leaking into your urine, which is necessary to maintain the right amount of fluid in your body. When the glomeruli are damaged, causing protein to leak into the urine, nephrotic syndrome occurs.

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Possible causes

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

  • Diabetic kidney disease: Diabetes can lead to kidney damage (diabetic nephropathy) affecting the glomeruli.
  • Minimal change disease: This is the most common cause of nephrotic syndrome in children. Minimal change disease causes abnormal kidney function, but kidney tissue appears normal or nearly normal when viewed under a microscope. The cause of abnormal function often cannot be determined.
  • Focal segmental glomerulosclerosis: This condition, characterized by scarring of certain glomeruli, may be caused by another disease, a genetic defect, or certain medications, or may occur for no known reason.
  • Membranous nephropathy: This kidney disorder is the result of thickening membranes in the glomeruli. The thickening is caused by deposits made by the immune system. Butterfly (lupus) disease may be associated with other medical conditions such as hepatitis B, malaria, and cancer, or it may occur for another reason.
  • Systemic lupus erythematosus: This chronic inflammatory disease can lead to serious kidney damage.
  • Amyloidosis: This disorder occurs when amyloid proteins build up in your organs. Amyloid buildup often damages the kidneys’ filtering system.

Who is at risk?

Factors that can increase your risk of nephrotic syndrome include:

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

What are the symptoms of nephrotic syndrome?

Nephrotic syndrome symptoms include:

  • Severe swelling (oedema), especially around your eyes, ankles and feet
  • Foamy urine as a result of excess protein in your urine
  • Weight gain due to fluid retention
  • Tiredness
  • Loss of appetite

When should you see a doctor?

If you have symptoms that worry you, you should talk to your doctor.

How is nephrotic syndrome diagnosed?

Tests and procedures used to diagnose this syndrome include:

  • Urine tests: A urinalysis can reveal abnormalities such as large amounts of protein in your urine. You may be asked to collect urine samples for 24 hours.
  • Blood tests: A blood test can show that levels of the protein albumin are low, and that overall levels of the blood protein are generally decreased. Loss of albumin is usually associated with an increase in blood cholesterol and blood triglycerides. The creatinine and urea nitrogen levels in your blood can also be measured to evaluate your overall kidney function.
  • Kidney biopsy: Your doctor may recommend removing a small sample of kidney tissue for testing. During a kidney biopsy, a needle is inserted through your skin into your kidney. Kidney tissue is collected and sent to a laboratory for testing.
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How is nephrotic syndrome treated?

Nephrotic syndrome treatment includes treating the underlying cause that triggered this condition. Your doctor may also suggest changes in your diet and medications to help control your symptoms or treat complications of nephrotic syndrome.

Medications may include:

  • Blood pressure medications: Medications called angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure and the amount of protein released in the urine. Medications in this category include lisinopril, benazepril, captopril, and enalapril. Another group of drugs that work similarly are called angiotensin 2 receptor blockers (ARBs), and these include losartan and valsartan. Other drugs such as renin inhibitors can also be used, but ACE inhibitors and ARBs are used first.
  • Diuretics: These help control swelling by increasing the fluid output of your kidneys. Diuretic medications typically contain furosemide. Others include spironolactone and thiazides such as hydrochlorothiazide or metolazone.
  • Cholesterol-lowering drugs: Statins can help lower cholesterol levels. However, it is unclear whether cholesterol-lowering drugs can improve outcomes for people with nephrotic syndrome, such as avoiding heart attacks or reducing the risk of premature death. Statins include atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin.
  • Blood thinners (anticoagulants): These may be prescribed to reduce your blood’s ability to clot, especially if you have a blood clot. Anticoagulants include heparin, warfarin, dabigatran, apixaban, and rivaroxaban.
  • Medicines that suppress the immune system: Medicines used to control the immune system, such as corticosteroids, can reduce the inflammation that accompanies some conditions that can cause this condition. Medications include rituximab, cyclosporine, and cyclophosphamide.

Remember, your doctor will decide which medicine to take and how.

Nutrition in nephrotic syndrome

Changes in your diet can help you with nephrotic syndrome. Your doctor may refer you to a dietitian who may recommend that you:

  • You can choose lean protein sources. Plant-based protein is beneficial in kidney disease.
  • You can reduce the amount of fat and cholesterol in your diet to help control your blood cholesterol levels.
  • You can be fed a low-salt diet to help control swelling.
  • You can reduce the amount of fluid in your diet.
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Nephrotic syndrome complications

Possible complications of nephrotic syndrome include:

  • Blood clots: The inability of the glomeruli to filter blood properly can lead to the loss of blood proteins that help prevent clotting. This increases your risk of developing blood clots in your veins.
  • High blood cholesterol and high blood triglycerides: When the level of the protein albumin in your blood drops, your liver makes more albumin. At the same time, your liver secretes more cholesterol and triglycerides.
  • Poor nutrition: Too much blood protein loss can lead to malnutrition. This can lead to weight loss, which can be masked by edema. You may also have too few red blood cells, low blood protein levels, and low vitamin D levels.
  • High blood pressure: Damage to your glomeruli and the resulting accumulation of excess body fluid can increase your blood pressure , causing high blood pressure .
  • Acute kidney damage: If your kidneys lose their ability to filter blood due to damage to the glomeruli, waste products can quickly build up in your blood. In this case, you may need emergency dialysis, which is an artificial way to remove extra fluids and wastes from your blood with a typical artificial kidney machine (dialyzer).
  • Chronic kidney disease: Nephrotic syndrome can cause the kidneys to lose their function over time. If kidney function is low enough, you may need dialysis or a kidney transplant.
  • Infections: People with nephrotic syndrome have an increased risk of infections.

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