Nephrotic syndrome
Nephrotic
syndrome
Overview
Nephrotic syndrome is a kidney disorder that
causes your body to pass too much protein in your urine.
Nephrotic syndrome is usually caused by damage
to the clusters of small blood vessels in your kidneys that filter waste and
excess water from your blood. The condition causes swelling, particularly in
your feet and ankles, and increases the risk of other health problems.
Treatment for nephrotic syndrome includes
treating the condition that's causing it and taking medications. Nephrotic
syndrome can increase your risk of infections and blood clots. Your doctor
might recommend medications and dietary changes to prevent complications.
Symptoms
Signs and symptoms of nephrotic syndrome
include:
·
Severe swelling
(edema), particularly around your eyes and in your ankles and feet
·
Foamy urine, a result
of excess protein in your urine
·
Weight gain due to
fluid retention
·
Fatigue
·
Loss of appetite
When to see a doctor
Make an appointment with your doctor if you
have signs or symptoms that worry you.
Causes
Nephrotic syndrome is usually caused by damage
to the clusters of tiny blood vessels (glomeruli) of your kidneys.
The glomeruli filter your blood as it passes
through your kidneys, separating things your body needs from those it doesn't.
Healthy glomeruli keep blood protein (mainly albumin) — which is needed to
maintain the right amount of fluid in your body — from seeping into your urine.
When damaged, glomeruli allow too much blood protein to leave your body,
leading to nephrotic syndrome.
Many 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) that affects the glomeruli.
·
Minimal
change disease. This is the most
common cause of nephrotic syndrome in children. Minimal change disease results
in abnormal kidney function, but when the kidney tissue is examined under a
microscope, it appears normal or nearly normal. The cause of the abnormal function
typically can't be determined.
·
Focal
segmental glomerulosclerosis. Characterized by scarring of some of the glomeruli, this
condition can result from another disease, a genetic defect or certain
medications or occur for no known reason.
·
Membranous
nephropathy. This kidney
disorder is the result of thickening membranes within the glomeruli. The
thickening is due to deposits made by the immune system. It can be associated
with other medical conditions, such as lupus, hepatitis B, malaria and cancer,
or it can occur for no known reason.
·
Systemic
lupus erythematosus. This chronic
inflammatory disease can lead to serious kidney damage.
·
Amyloidosis. This disorder occurs when amyloid
proteins accumulate in your organs. Amyloid buildup often damages the kidneys'
filtering system.
Risk factors
Factors that can increase your risk of
nephrotic syndrome include:
·
Medical
conditions that can damage your kidneys. Certain diseases and conditions increase your risk of
developing nephrotic syndrome, such as diabetes, lupus, amyloidosis, reflux
nephropathy and other kidney diseases.
·
Certain
medications. Medications that
might cause nephrotic syndrome include nonsteroidal 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.
Complications
Possible complications of nephrotic syndrome
include:
·
Blood
clots. The inability of
the glomeruli to filter blood properly can lead to loss of blood proteins that
help prevent clotting. This increases your risk of developing a blood clot in
your veins.
·
High
blood cholesterol and elevated blood triglycerides. When the level of the protein albumin in
your blood falls, your liver makes more albumin. At the same time, your liver
releases more cholesterol and triglycerides.
·
Poor
nutrition. Loss of too much
blood protein can result in malnutrition. This can lead to weight loss, which
can be masked by edema. You may also have too few red blood cells (anemia), low
blood protein levels and low levels of vitamin D.
·
High
blood pressure. Damage to your
glomeruli and the resulting buildup of excess body fluid can raise your blood
pressure.
·
Acute
kidney injury. If your kidneys
lose their ability to filter blood due to damage to the glomeruli, waste
products can build up quickly in your blood. If this happens, you might need
emergency dialysis — an artificial means of removing extra fluids and waste
from your blood — typically with an artificial kidney machine (dialyzer).
·
Chronic
kidney disease. Nephrotic
syndrome can cause your kidneys to lose their function over time. If kidney
function falls low enough, you might need dialysis or a kidney transplant.
·
Infections. People with nephrotic syndrome have an
increased risk of infections.
Diagnosis
Tests and procedures used to diagnose
nephrotic syndrome include:
·
Urine
tests. A urinalysis can
reveal abnormalities in your urine, such as large amounts of protein. You might
be asked to collect urine samples over 24 hours.
·
Blood
tests. A blood test can
show low levels of the protein albumin and often decreased levels of blood
protein overall. Loss of albumin is often associated with an increase in blood
cholesterol and blood triglycerides. The creatinine and urea nitrogen levels in
your blood also might be measured to assess your overall kidney function.
·
Kidney
biopsy. Your doctor
might recommend removing a small sample of kidney tissue for testing. During a
kidney biopsy, a needle is inserted through your skin and into your kidney. Kidney
tissue is collected and sent to a lab for testing.
Treatment
Treatment for nephrotic syndrome involves
treating any medical condition that might be causing your nephrotic syndrome.
Your doctor might also recommend medications and changes in your diet to help
control your signs and symptoms or treat complications of nephrotic syndrome.
Medications might include:
·
Blood
pressure medications. Drugs called
angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure and the
amount of protein released in urine. Medications in this category include
lisinopril (Prinivil, Qbrelis, Zestril), benazepril (Lotensin), captopril and
enalapril (Vasotec).
Another group of drugs that works similarly is called
angiotensin II receptor blockers (ARBs) and includes losartan (Cozaar) and
valsartan (Diovan). Other medications, such as renin inhibitors, also might be
used, though ACE inhibitors and ARBs are generally used
first.
·
Water
pills (diuretics). These help
control swelling by increasing your kidneys' fluid output. Diuretic medications
typically include furosemide (Lasix). Others include spironolactone (Aldactone,
Carospir) and thiazides, such as hydrochlorothiazide or metolazone (Zaroxolyn).
·
Cholesterol-reducing
medications. Statins can help
lower cholesterol levels. However, it's not clear whether cholesterol-lowering
medications can improve the outcomes for people with nephrotic syndrome, such
as avoiding heart attacks or decreasing the risk of early death.
Statins include atorvastatin (Lipitor), fluvastatin (Lescol XL),
lovastatin (Altoprev), pravastatin (Pravachol), rosuvastatin (Crestor, Ezallor)
and simvastatin (Zocor).
·
Blood
thinners (anticoagulants). These
might be prescribed to decrease your blood's ability to clot, especially if
you've had a blood clot. Anticoagulants include heparin, warfarin (Coumadin,
Jantoven), dabigatran (Pradaxa), apixaban (Eliquis) and rivaroxaban (Xarelto).
·
Immune
system-suppressing medications. Medications to control the immune system, such as
corticosteroids, can decrease the inflammation that accompanies some of the
conditions that can cause nephrotic syndrome. Medications include rituximab
(Rituxan), cyclosporine and cyclophosphamide.
Lifestyle and home
remedies
Changes to your diet might help with nephrotic
syndrome. Your doctor might refer you to a dietitian, who might recommend that
you do the following:
·
Choose lean sources of
protein. Plant-based protein is helpful in kidney disease.
·
Reduce the amount of
fat and cholesterol in your diet to help control your blood cholesterol levels.
·
Eat a low-salt diet to
help control swelling.
·
Reduce the amount of
liquid in your diet.
Preparing for your
appointment
Start by seeing your primary care doctor. If
your doctor suspects you or your child has a kidney problem, such as nephrotic
syndrome, you might be referred to a doctor who specializes in the kidneys
(nephrologist).
Here's some information to help you get ready
for your appointment.
What you can do
When you make the appointment, ask if there's
anything you need to do in advance, such as restrict your diet. Take a family
member or friend along, if possible, to help you remember the information
you'll be given.
Make a list of:
·
Your
or your child's symptoms and
when they began
·
Key
personal information, including major
stresses or recent life changes
·
All
medications, vitamins or other supplements you or your child takes, including doses
·
Questions
to ask your doctor
For nephrotic syndrome, some questions to ask
include:
·
What's the most likely
cause of my or my child's nephrotic syndrome?
·
What tests do I or my
child need?
·
Is this condition
likely temporary?
·
What are the treatment
options? And which do you recommend?
·
Are there changes I
can make to my or my child's diet? Could consulting a dietitian help?
·
How can I best manage
this condition with my or my child's other medical conditions?
·
Are there brochures or
other printed material that I can have? What websites do you recommend?
What to expect from
your doctor
Your doctor is likely to ask you questions,
such as:
·
Do symptoms come and
go, or do you have them all the time?
·
How severe are the
symptoms?
·
Does anything seem to
improve the symptoms?
·
What, if anything,
appears to worsen the symptoms?
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