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Nephrotic syndrome

Definition

Nephrotic syndrome is a group of symptoms that include protein in the urine, low blood protein levels in the blood, high cholesterol levels, high triglyceride levels, and swelling.

Alternative Names

Nephrosis

Causes

Nephrotic syndrome is caused by different disorders that damage the kidneys. This damage leads to the release of too much protein in the urine.

The most common cause in children is minimal change disease. Membranous glomerulonephritis is the most common cause in adults. In both diseases, the glomeruli in the kidneys are damaged. Glomeruli are the structures that help filter wastes and fluids.

This condition can also occur from:

  • Cancer
  • Diseases such as diabetes, systemic lupus erythematosus, multiple myeloma, and amyloidosis
  • Genetic disorders
  • Immune disorders
  • Infections (such as strep throat, hepatitis, or mononucleosis)
  • Use of certain drugs

It can occur with kidney disorders such as:

  • Focal and segmental glomerulosclerosis
  • Glomerulonephritis
  • Mesangiocapillary glomerulonephritis

Nephrotic syndrome can affect all age groups. In children, it is most common between ages 2 and 6. This disorder occurs slightly more often in males than females.

Symptoms

Swelling (edema) is the most common symptom. It may occur:

  • In the face and around the eyes (facial swelling)
  • In the arms and legs, especially in the feet and ankles
  • In the belly area (swollen abdomen)

Other symptoms include:

  • Skin rash or sores
  • Foamy appearance of the urine
  • Poor appetite
  • Weight gain (unintentional) from fluid retention
  • Seizures

Exams and Tests

The doctor will perform a physical exam. Laboratory tests will be done to see how well the kidneys are working. They include:

  • Albumin blood test
  • Blood chemistry tests such as basic metabolic panel or comprehensive metabolic panel
  • Blood urea nitrogen (BUN)
  • Creatinine - blood test
  • Creatinine clearance - urine test
  • Urinalysis

Fats are often also present in the urine. Blood cholesterol and triglyceride levels may be high.

A kidney biopsy may be needed to find the cause of the disorder.

Tests to rule out various causes may include the following:

  • Antinuclear antibody
  • Cryoglobulins
  • Complement levels
  • Glucose tolerance test
  • Hepatitis B and C antibodies
  • HIV test
  • Rheumatoid factor
  • Serum protein electrophoresis (SPEP)
  • Syphilis serology
  • Urine protein electrophoresis (UPEP)

This disease may also change the results of the following tests:

  • Vitamin D level
  • Serum iron
  • Urinary casts

Treatment

The goals of treatment are to relieve symptoms, prevent complications, and delay kidney damage. To control nephrotic syndrome, the disorder that is causing it must be treated. You may need treatment for life.

Treatments may include any of the following:

  • Keeping blood pressure at or below 130/80 mm Hg to delay kidney damage. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are the medicines most often used. ACE inhibitors and ARBs may also help decrease the amount of protein lost in the urine.
  • Corticosteroids and other drugs that suppress or quiet the immune system.
  • Treating high cholesterol to reduce the risk of heart and blood vessel problems. A low-fat, low-cholesterol diet is usually not enough for people with nephrotic syndrome. Medicines to reduce cholesterol and triglycerides (usually statins) may be needed.
  • A low-salt diet may help with swelling in the hands and legs. Water pills (diuretics) may also help with this problem.
  • Low-protein diets may be helpful. Your health care provider may suggest a moderate-protein diet (1 gram [gm] of protein per kilogram [kg] of body weight per day).
  • Taking vitamin D supplements if nephrotic syndrome is long-term and is not responding to treatment.
  • Taking blood thinner drugs to treat or prevent blood clots.

Outlook (Prognosis)

Outcome varies. Some people recover from the condition. Others develop long-term kidney disease and need dialysis and eventually a kidney transplant.

Possible Complications

Health problems that may result from nephrotic syndrome include:

  • Acute kidney failure
  • Atherosclerosis and related heart diseases
  • Chronic kidney disease
  • Fluid overload, congestive heart failure, pulmonary edema
  • Infections, including pneumococcal pneumonia
  • Malnutrition
  • Renal vein thrombosis

When to Contact a Medical Professional

Call your provider if:

  • You develop symptoms of nephrotic syndrome, including swelling in face, belly, or arms and legs, or skin sores
  • You're being treated for nephrotic syndrome, but your symptoms don't improve
  • New symptoms develop, including cough, decreased urine output, discomfort with urination, fever, severe headache

Go to the emergency room or call the local emergency number (such as 911) if you have seizures.

Prevention

Treating conditions that can cause nephrotic syndrome may help prevent the syndrome.

References

Nachman PH, Jennette JC, Falk RJ. Primary glomerular disease. In: Taal MW, Chertow GM, Marsden PA, Skorecki K, Yu ASL, Brenner BM, eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 31.

Pais P, Avner ED. Nephrotic syndrome. In: Kliegman RM, Stanton BF, St Geme JW III, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 527.



Review Date: 9/22/2015
Reviewed By: Charles Silberberg, DO, private practice specializing in nephrology, affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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