Nephrotic Syndrome

Nephrotic syndrome is a collection of symptoms indicating kidney damage, specifically to the glomeruli, which are the blood vessels within the kidneys responsible for filtering waste and excess fluids from the blood. This condition leads to severe swelling, particularly in the legs and feet, due to the loss of large amounts of protein in the urine.

Causes

Nephrotic syndrome can result from various causes, including:

• Focal segmental glomerulosclerosis (FSGS), a disease in which scar tissue develops on the parts of the kidneys that filter waste from the blood.
• Minimal change disease, the most common cause of nephrotic syndrome in children, characterized by the normal appearance of the kidney's filters under light microscopy but with changes visible under electron microscopy.
• Membranous nephropathy, a condition where changes occur in the membranes of the glomeruli.
• Diabetic nephropathy, resulting from long-standing diabetes.
• Lupus nephritis, associated with systemic lupus erythematosus (SLE), an autoimmune disease.

Symptoms

The primary symptoms of nephrotic syndrome include:

• Severe swelling (edema), particularly in the legs and feet but can also occur in other parts of the body such as the face, hands, and abdomen.
• Proteinuria, which is the presence of an excessive amount of protein in the urine. Normally, the kidneys keep protein in the blood, but when they are damaged, this protein leaks into the urine.
• Hypoalbuminemia, a condition characterized by low levels of albumin (a type of protein) in the blood. Albumin helps to keep fluid in your bloodstream so that it doesn’t leak into other tissues. Low albumin can lead to edema.
• Hyperlipidemia, or high levels of cholesterol and triglycerides in the blood, which occurs because the liver produces more lipids when it senses low albumin levels.
• Fatigue
• Weight gain due to fluid retention

Treatments

The treatment of nephrotic syndrome focuses on reducing symptoms, slowing disease progression, and treating the underlying cause. Treatments may include:

• Corticosteroids, such as prednisone, which are often the first line of treatment to reduce proteinuria and swelling.
• Immunosuppressive medications for cases where corticosteroids are not effective or when the syndrome is due to an autoimmune disease.
• Diuretics to help manage edema by increasing urine production.
• ACE inhibitors or ARBs (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers) to reduce proteinuria and protect kidney function.
• Statins to control high cholesterol levels associated with nephrotic syndrome.
• Salt restriction and a low-sodium diet to help manage edema.
• Protein intake may need to be adjusted based on the severity of proteinuria and kidney function.

Lifestyle Changes

In addition to medical treatments, certain lifestyle changes can help manage nephrotic syndrome:

• Maintaining a healthy weight through diet and exercise.
• Following a low-sodium diet to reduce fluid retention.
• Avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) which can worsen kidney function.
• Getting vaccinated against infections such as pneumonia and influenza, as individuals with nephrotic syndrome may be at higher risk of developing severe infections.

Prognosis

The prognosis for nephrotic syndrome varies depending on the underlying cause. Some forms, like minimal change disease, often respond well to corticosteroid treatment and have a good prognosis. Others, such as those associated with diabetes or lupus, may be more challenging to manage and can lead to chronic kidney disease or end-stage renal disease over time.