• Nephrotic Syndrome—Child

    (Nephrosis—Child)

    Definition

    Nephrotic syndrome is a group of symptoms that indicate problems with kidney function. These may include:
    • Excess protein in the urine
    • Swelling in limbs or abdomen from excess fluid
    • Sudden weight gain
    • High cholesterol levels in the blood
    There are 2 types of nephrotic syndrome:
    • Primary—Linked to changes in the kidney itself. This is the most common type.
    • Secondary—Associated with medications or other diseases, such as an infection, autoimmune disease, or a blood disorder.
    Anatomy of the Kidney
    Glomerulonephritis
    Copyright © Nucleus Medical Media, Inc.

    Causes

    The kidneys filter out wastes and excess fluid from the blood, while keeping important elements, like proteins, in the blood. The kidney can get injured by substances in the blood, from infections, autoimmune diseases, and other factors. The injury affects the microscopic filters of the kidney, making it harder for the kidneys to work properly. Proteins, which are supposed to stay in the blood, get filtered out and excreted in the urine. Over time, chronic injury causes waste products that should be filtered out to stay in the blood.
    This is likely related to genetic or immune system factors. In children, the most common known cause is minimal change disease.

    Risk Factors

    Nephrotic syndrome is more common in males. Other factors that may increase the risk of kidney injury include:

    Symptoms

    Nephrotic syndrome may cause:
    • Swelling (edema) from excess fluid in the:
      • Face, especially under the eyes or around the lips
      • Abdomen
      • Legs, ankles, or feet
      • Lungs—may cause difficulty breathing
    • High blood pressure
    • Fatigue
    • Pale skin
    • Irritability
    • Weight gain from excess fluid in the body
    • General feeling of illness—malaise
    • Lack of appetite
    • Foamy urine

    Diagnosis

    The doctor will ask about your child’s symptoms and medical history. A physical exam will be done, which includes checking your child’s blood pressure.
    To see how well the kidneys are working your doctor may take:
    • Urine tests to look for blood and abnormal levels of substances like protein
    • Blood tests to check protein levels and for substances normally filtered by the kidneys
    A kidney biopsy may also be done. A sample of kidney tissue is removed and examined to look for change to kidney tissue.
    On rare occasions kidney ultrasound may be done to look for structural problems or blockages

    Treatment

    Nephrotic syndrome can be managed. Treatment options may depend on the cause and type of nephrotic syndrome.
    For primary nephrotic syndrome, corticosteroids may control the disease. Other treatment will be given to manage symptoms like fluid retention or high blood pressure. In many children, nephrotic syndrome resolves with age without long-term kidney damage.
    With secondary nephrotic syndrome, the underlying condition will be treated. Other symptoms will also be treated.
    Some children may have periods of remission when nephrotic syndrome does not cause problems. There may be other times when there is a relapse and symptoms are more active.
    In some children, the first episode may require hospitalization to treat more severe symptoms like breathing problems. Medications may given through an IV until your child is stabilized.

    Dietary Changes

    Certain changes to the diet will help reduce symptoms, like swelling. The doctor may recommend limiting salt, saturated fats, cholesterol, and fluids.
    Changes to dietary intake may change as your child grows and their condition improves.

    Medications

    Medications can be used to manage symptoms. These may include:
    • Corticosteroids or other medications to suppress the effects of the immune system and improve kidney function
    • Diuretics to increase urine output and reduce swelling
    • Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers to reduce the amount of protein in the urine and control high blood pressure
    If medications are causing nephrotic syndrome, your child’s doctor may stop or change them.
    The doctor may advise certain vaccines for your child or family to reduce the risk of infection. These may include vaccines for the flu or pneumonia.

    Prevention

    There are no current guidelines to prevent nephrotic syndromes because in most cases, the causes are unknown.

    RESOURCES

    National Institute of Diabetes and Digestive and Kidney Disorders https://www.niddk.nih.gov

    National Kidney Foundation https://www.kidney.org

    CANADIAN RESOURCES

    Caring for Kids—Canadian Paediatric Society http://www.caringforkids.cps.ca

    The Kidney Foundation of Canada http://kidney.ca

    References

    Childhood nephrotic syndrome. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/health-topics/kidney-disease/nephrotic-syndrome-in-children/Pages/index.aspx. Updated September 2014. Accessed October 28, 2016.

    Childhood nephrotic syndrome. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/childns. Accessed October 28, 2016.

    Nephrotic syndrome. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/en/parents/nephrotic-syndrome.html. Updated March 2014. Accessed October 28, 2016.

    Nephrotic syndrome in children. Children’s Hospital of Philadelphia website. Available at: http://www.chop.edu/conditions-diseases/nephrotic-syndrome-children. Accessed October 28, 2016.

    Nephrotic syndrome in children. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T900359/Nephrotic-syndrome-in-children. Updated April 4, 2016. Accessed October 28, 2016.

    Revision Information

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