Nephrotic syndrome


What is it about ?

The kidneys are made up of millions of microscopic filters (the glomeruli). Blood flows continuously through these filters. Filters clean the blood permanently: they rid the blood of excess waste and water, and keep the amount of salts within certain limits. What is in excess is evacuated via the urine.

Sometimes these filters are damaged. This destabilizes the water balance in the body. Some wastes can build up in the blood. The filters can let out elements that would not normally pass through the filter, such as proteins or red blood cells for example. The blood then contains too little protein, and these proteins and red blood cells are found in the urine.

If the kidney filters keep getting damaged, they eventually don’t work at all. In this case, the waste remains in the blood, which can be toxic to the body.

Nephrotic syndrome is a collection of symptoms related to the fact that there is too little protein in the blood. One of these symptoms is fluid retention.

The cause of nephrotic syndrome is not always clear. The cause may be, for example,

  • diabetes (the most common cause),
  • pregnancy,
  • an autoimmune disease.

In whom and how often does it occur?

Nephrotic syndrome is a rare disease. It is found in about 2 in 100,000 children per year. Each year, 3 in 100,000 adults develop the disease for the first time. Nephrotic syndrome most often occurs between the ages of 20 and 50.

How to recognize it?

The signs of this condition, linked to the loss of protein by the kidneys, are signs of water retention (edema): swelling especially in the ankles, legs (during the day), stomach and eyelids ( night).

General symptoms include loss of appetite, general ill-feeling, fatigue, stomach pain, weight gain, and high blood pressure. Other possible signs are an increased level of fat in the blood (leading to arteriosclerosis), increased susceptibility to infections and abnormal blood clotting with an increased risk of blood clots (thrombosis).

In advanced cases, urine production decreases. The person therefore urinates less often.

This condition can progress quickly (over a few days) or more slowly (over a few weeks).

How is the diagnosis made?

The doctor makes the diagnosis based on the symptoms and the results of urine and blood tests. Most often, a kidney biopsy is needed to look for the cause of nephrotic syndrome. A small piece of tissue from the kidney is taken in the hospital and examined under a microscope.

What can you do ?

Nephrotic syndrome is a serious illness. You should therefore consult the doctor as soon as possible. If symptoms appear quickly, within a few days, emergency hospitalization is required. Take your medication properly as prescribed by your doctor. Follow your diet well and especially limit salt. Make sure you have a correct intake of good quality protein (meat, poultry, fish).

What can the doctor do?

The doctor will treat the cause that caused the nephrotic syndrome (infection, drugs, or autoimmune disease). At an advanced stage, it is necessary to pass to the kidney dialysis, and a kidney transplant may even be necessary.

The doctor will also treat the symptoms. Thus, he will prescribe suitable drugs to correct the loss of protein and blood pressure. It can slow down or even stop the disease.

By limiting salt intake or taking a diuretic, water retention will decrease. Calcium and vitamin D supplements are recommended. If the concentration of fat in the blood is too high, the doctor will prescribe cholesterol-lowering drugs. A small dose of aspirin is helpful in reducing the risk of blood clots forming.

Want to know more?

Source

Foreign clinical practice guide ‘Nephrotic syndrome’ (2000), updated on 22.05.2017 and adapted to the Belgian context on 02.07.2019 – ebpracticenet