Nephrotic syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 1, 2016
StartDiseasesNephrotic syndrome

A condition that results from a person having kidney damage is known as nephrotic syndrome. It often happens when a person has damage to the glomeruli which are located in the kidneys and help to filter blood. This condition can result in swelling of the ankles and feet as well as an elevated risk of developing other health problems.

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Definition & Facts

Nephrotic syndrome appears with a variety of symptoms that are associated with kidney damage. A person could have hyperlipidemia. This is an elevated level of cholesterol and fat in their blood. There is also a condition that causes large levels of protein in a person's urine known as proteinuria.

When a person has low levels of albumin in their blood, it is known as hypoalbuminemia. There are approximately 39,000 individuals who die annually from nephrotic syndrome. Death from kidney disease is ranked as the ninth leading cause of death in the United States. Over 78 percent of hospital visits resulting from nephrotic syndrome require hospital admission.

Symptoms & Complaints

A person suffering from nephrotic syndrome will likely experience hypoalbuminemia. This condition occurs when a person has low albumin, which is a protein, in the blood. Hypoalbuminemia will cause fluid to move from the blood into the tissue of the body. This will result in swelling.

A person's kidney responds to the decrease in fluid by retaining as much fluid and salt as is possible. This will result in a person's body being in a state of fluid overload. This makes the body's tissue puffy and soft. It may be impressionable to the touch. This condition is known as edema. It occurs most commonly in a person's feet and legs. The level of edema could be significant after a person has been standing for a long period of time.

A person with nephrotic syndrome could also feel tightness in their extremities, which could impact their mobility. During the later stages of this condition, a person may have swelling in their hands, abdomen, as well as eyes. In the final stages, a person may experience their entire body swelling. People will experience significant weight gain from fluid building up in their body.

Renal vein thrombosis is a blood clot in a kidney vein that can be a complication of nephrotic syndrome. It can manifest as flank pain.

Causes

Nephrotic syndrome is caused by damage to a cluster of small blood vessels in a person's kidneys. These blood vessels are known as glomeruli. They filter a person's blood as it passes through their kidneys. It filters out substances a person's body does not need. Healthy glomeruli prevent blood protein from entering a person's urine. Nephrotic syndrome is caused when the glomeruli permits too much blood protein into a person's urine.

Nephrotic syndrome can be caused by a number of kidney diseases as well as different systemic diseases. The former are said to be primary causes and the latter are said to be secondary - conditions that affect various parts of a person's body. Membranous nephropathy is a kidney disorder resulting from an increased thickness in the kidney's membranes, and it is a common primary cause of nephrotic syndrome.

Diabetes mellitus is the most common secondary cause. Other medical conditions that can cause nephrotic syndrome include lupus, cancer, HIV, hepatitis B, preeclampsia, malaria, and syphilis. Amyloidosis is a condition where amyloid proteins accumulate in a person's kidney and damages its ability to filter the blood.

Diagnosis & Tests

In order to determine if a person has nephrotic syndrome, a urine sample will have to be taken. Diagnosis consists of determining if large amounts of protein are in a person's urine. The presence of protein in a person's urine is able to be identified with a dipstick test used with a urine sample. A medical professional will put the chemically treated dipstick into the urine. It will change color in certain areas when protein is present.

Urine tests will also measure the ratio of albumin to creatinine, which is a waste product created when healthy muscle breaks down. A blood test will identify kidney function problems. A low level of the blood protein albumin and other proteins also support a diagnosis of nephrotic syndrome.

The most accurate diagnosis tool is a kidney biopsy. This is when a sample of a person's kidney is removed and analyzed. Imaging studies such as magnetic resonance imaging (MRI) scans and renal ultrasounds may also detect abnormalities in the structure and function of the kidneys and detect complications such as renal vein thrombosis.

Treatment & Therapy

Often physicians will design a treatment program for nephrotic syndrome to address any underlying medical conditions first. If the underlying cause is lupus, then corticosteroids may be prescribed. If the underlying cause is membraneous nephropathy, then angiotensin-converting enzyme (ACE) inhibitors may be prescribed. These medications can help reduce proteinuria.

There has been success using blood pressure medications. When a person's blood pressure is decreased, the level of protein released in their urine is also reduced. Water pills or diuretics are able to help control the swelling that results from an increase in the fluid output of a person's kidneys. These help address edema.

Medication designed to reduce cholesterol has also been effective. These include statins, and they help to lower people's risk of having a heart attack. Medications for suppressing the immune system can also help. They have been effective in reducing the inflammation that comes with this type of kidney disorder.

Blood thinning medication is able to help the blood in a person's body to not clot. An example is warfarin.

Prevention & Prophylaxis

Preventing nephrotic syndrome involves treating the conditions that can result in developing it. People will be recommended to carefully control their blood pressure. This can be accomplished with drugs, healthy diet, and regular exercise. It is important for a diabetic to carefully control their blood glucose level.

Patients will be advised to quit smoking or using any type of tobacco products. People are recommended to stop working outdoors at the first sign of dizziness. They should stop exercising if they feel lightheaded. A person needs to avoid medications that harm the kidney.