Nephrotic syndrome is a kidney disorder in which too much protein is passed in the urine, resulting in puffiness over the face, and tiredness. It is usually caused due to damage to the small blood vessels of the kidneys. It causes swelling, particularly of the face and ankles, and increases the risk of other health problems. It occurs in both children and adults. Children from two to five years, mostly male, are likely to develop it, whereas in adults, it can happen at any age in both genders. Nephrotic syndrome is usually caused by damage to the glomeruli (tufts of small blood vessels in the kidney). These glomeruli filter blood, separating useful substances from useless ones. Healthy glomeruli retain the right amount of fluid and proteins, which are essential for the body. Damaged glomeruli derange this function. Many diseases can damage the glomeruli, resulting in nephrotic syndrome. Uncontrolled diabetes or even long-term diabetes is known to harm the kidneys, including the small blood vessels, resulting in nephrotic syndrome. Minimal change disease is one of the most common causes of nephrotic syndrome in children. Focal scarring of some of the glomeruli, due to some disease process or medicines (some painkillers, diuretics, anabolic steroids, and bisphosphonates used to treat osteoporosis) also can cause some focal damage to glomeruli, resulting in nephrotic syndrome. The response varies from individual to individual. Thickening of the glomerular membrane is also implicated in causing nephrotic syndrome. It can be due to diseases like amyloidosis, and systemic lupus erythematosus, that cause kidney damage and nephrotic syndrome. Certain infections like hepatitis B, C, HIV, and malaria, also increase the risk of nephrotic syndrome. Due to the loss of protein in the urine, the ability to prevent clotting is reduced, thus resulting in an increased risk of blood clot formation in the veins. The liver has to make more albumin as blood albumin levels become low. Simultaneously, it releases more cholesterol and triglycerides, thus raising their blood levels. This increases the risk of heart disease and strokes. High blood pressure occurs due to excess fluid in the body. Protein loss leads to reduced immunity, thus increasing risk of infection. Along with it, deficiency of iron and vitamin D also occurs. This malnutrition is masked by the swelling that occurs in nephrotic syndrome. Kidney functions are deranged due to the damage, resulting in kidney failure, necessitating dialysis and or kidney transplant. Diagnosis of nephrotic syndrome is based on physical examination, urine examination, which shows the presence of albumin, and blood test which reveals high cholesterol and triglycerides. Kidney biopsy if done can reveal the underlying cause. Treatment includes dietary restriction of salt and fats. Plant-based proteins are good to take in the diet. Supplements of iron and vitamin D, help to overcome their deficiency. It is useful to take green vegetables and fresh fruits. Diuretic drugs (that remove extra fluid and salt from the body), are given regularly. Anti-hypertensive drugs of the group called angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs) are used to control high blood pressure. High cholesterol is reduced by cholesterol-reducing drugs like statins. If there is a risk for blood clots to form, anti-clotting drugs are prescribed. Corticosteroids are used to reduce the ongoing inflammation that is present in many conditions that cause nephrotic syndrome. Prevention of all causes of nephrotic syndrome is not possible, but certain known risk factors can be prevented. Hypertension and or diabetes if present, should be well controlled by diet restrictions, regular physical exercise, and medicines. One should get vaccinated against common infections and, in the presence of any infection, take a complete course of antibiotics prescribed. Maintaining a healthy body weight, balanced diet, regular physical exercise, and avoiding tobacco and alcohol use, are useful in keeping the body healthy and avoiding infections that can lead to nephrotic syndrome. Dr Rachna Pande is a specialist in internal medicine. rachna212002@yahoo.co.uk
