Causes and risk factors
Nephrotic syndrome is caused due to damage to the glomeruli, tiny units that filter the blood in the kidney. This causes leakage of protein from blood into the urine. This results in increased protein excretion, reduced levels of protein [albumin] in the blood. Abnormalities of kidney lead to collection of fluid in the tissues causing oedema. Nephrotic syndrome can be caused due to primary or secondary causes. Primary are those which begin in the kidney and affects only kidneys. These are most common type of childhood nephrotic syndrome. The causes include minimal change disease, focal glomerulosclerosis, membranous glomerulonephritis, and hereditary nephropathies. Secondary causes are renal manifestation of underlying systemic disease such as mesangial proliferative glomerulonephritis , rapidly progressive glomerulonephritis, diabetic nephropathy, systemic lupus erythematosus , sarcoidosis , Hepatitis B , HIV , Amyloidosis, Renal vein thrombosis. Heart diseases that cause nephrotic syndrome are constrictive pericarditis, Right heart failure.
Clinical presentation
Peripheral oedema is a hallmark of the nephrotic syndrome. Initially this presents in the dependent areas of the body such as the lower extremities; however, such oedema can become generalized. Puffiness under eyes, pitting oedema over legs can be seen. There is unintentional weight gain. Patients can experience dyspnoea due to pulmonary oedema, pleural effusions, and diaphragmatic compromise with ascites. Complaints of abdominal fullness may also be present in patients with ascites. Patients with nephrotic syndrome present with foamy urine. Hyperlipidemia along with raised blood pressure is seen in many cases.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Tests such as 24 hours urine is collected for urinalysis to measure protein levels in urine. Blood test to measure albumin, cholesterol and triglyceride levels is done. Kidney function test is advised. Renal biopsy may be required.
Treatment
Treatment for nephrotic syndrome depends upon the underlying cause. However supportive care is given to reduce the symptoms and prevent complications. The daily total dietary protein intake should replace the daily urinary protein losses. Dietary salt restriction is essential for managing oedema; most patients also require diuretic therapy. Statins to reduce cholesterol level and dietary modification and exercise should be advocated. Anticoagulation therapy is required in patients with hypercoagulable state to prevent blood clotting. Blood pressure stabilising is necessary.
Other Modes of treatment
The other modes of treatment can also be effective in treating nephrotic syndrome.
Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating nephrotic syndrome.
Facts and figures
About 1/3rd of patients with nephrotic syndrome have a systemic renal disease such as diabetes mellitus, amyloidosis, or systemic lupus erythematosus. About 5 out of 1,00,000 children are diagnosed with nephrotic syndrome every year.
