Nephrotic Syndrome

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Introduction

What is nephrotic syndrome?

Nephrotic syndrome is a disorder that indicates damaged kidneys. It refers to a group of symptoms, including protein in the urine, low blood protein, and high cholesterol.

Nephrotic syndrome can occur in anyone. The syndrome arises for many reasons, including a condition known as minimal change disease in children and glomerulonephritis (kidney inflammation) in adults. Nephrotic syndrome can also be caused by infection, medication side effects, heredity, cancer, and autoimmune disorders, such as diabetes and lupus.

Other symptoms and signs of nephrotic syndrome are foamy urine, unexplained weight gain, loss of appetite, high blood pressure, and edema (swelling), especially in the face, feet and abdomen. Treatment for nephrotic syndrome is aimed at controlling these symptoms.

Nephrotic syndrome may be treated with blood pressure medications, such as angiotensin receptor blockers and angiotensin-converting enzyme inhibitors. Immunosuppressant drugs and drugs to treat high cholesterol may also be used, depending upon the cause. Proper medical treatment may help prevent further damage to the kidneys.

Seek immediate medical care (call 911) for serious symptoms of nephrotic syndrome, such as convulsions or difficulty breathing.

Seek prompt medical care for persistent or bothersome symptoms of nephrotic syndrome, including fever, headache, painful urination, or changes in amount and frequency of urination.

Symptoms

What are the symptoms of nephrotic syndrome?

Symptoms of nephrotic syndrome are related to improper functioning of the kidneys, leading to improper handling of body waste. Nephrotic syndrome is often progressive (gets worse with time), so early stages of the syndrome may be symptomless. In late stages, nephrotic syndrome may progress to kidney failure.

Common symptoms of nephrotic syndrome

You may experience nephrotic syndrome symptoms daily or only occasionally. Any of these symptoms can be severe:

  • Edema (swelling) of the face, limbs, or abdomen
  • Foamy urine
  • Loss of appetite
  • Unexplained weight gain

Other symptoms of nephrotic syndrome

As nephrotic syndrome progresses, other symptoms may develop including:

Serious symptoms that might indicate a life-threatening condition

In some cases, nephrotic syndrome can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Bloody urine (hematuria)
  • Convulsions
  • Difficulty breathing
  • Flank pain
  • High fever (above 101F)
  • Reduced or absent urine formation (oliguria/anuria)

Causes

What causes nephrotic syndrome?

Nephrotic syndrome is caused by damage to the kidneys, generally as the result of another disorder. The part of the kidney that becomes damaged is called the glomerulus, or the filtering unit of the kidney. When glomeruli are damaged, they cannot handle waste in the bloodstream properly, so they fail to block the passage of protein into the urine. The body then retains excess water, leading to swelling.

Common causes of nephrotic syndrome

Nephrotic syndrome generally results from another disorder that damages the kidneys, such as:

  • Amyloidosis (rare immune-related disorder characterized by protein buildup in organs and tissues that can cause serious complications)

  • Certain infectious diseases such as viral hepatitis

  • Certain medications, especially nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Diabetes (chronic disease that affects your body’s ability to use sugar for energy)

  • Glomerulonephritis (kidney inflammation)

  • Glomerulosclerosis (kidney scarring)

  • Minimal change disease (kidney disease in which the kidneys appear microscopically normal)

  • Multiple myeloma (cancer of plasma cells in the bone marrow)

  • Other autoimmune disorders

  • Substance abuse

  • Systemic lupus erythematosus (disorder in which the body attacks its own healthy cells and tissues)

What are the risk factors for nephrotic syndrome?

A number of factors increase the risk of developing nephrotic syndrome. Not all people with risk factors will get nephrotic syndrome. Risk factors include:

  • Certain cancer medications

  • Chronic painkiller abuse

  • Diabetes

  • Family history of autoimmune disorders

  • Personal history of autoimmune disorders

  • Recent infection

  • Substance abuse

Treatments

How is nephrotic syndrome treated?

In some cases, nephrotic syndrome may be symptomless or mild and not require treatment. If symptoms appear, however, it is important to treat them because further damage to the kidneys can occur over time. The most important symptom to treat is high blood pressure. Controlling autoimmune symptoms and lowering blood cholesterol are also important goals of treating nephrotic syndrome.

Medications for nephrotic syndrome

Nephrotic syndrome symptoms are treated with a variety of medications including:

  • Blood pressure medications, such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, which prevent further damage to the glomeruli

  • Blood thinners, which prevent clots from forming

  • Cholesterol-reducing medications such as statins, which control blood cholesterol levels

  • Corticosteroids, which control inflammation

  • Diuretics, which reduce swelling

  • Vitamin supplements such as vitamin D, which replace lost vitamins and minerals

Other treatments for nephrotic syndrome

In addition to medication, other treatments may be used to help control the symptoms of nephrotic syndrome including:

  • Dietary modification such as salt reduction to reduce swelling

  • Low protein diets to prevent protein accumulation

What are the potential complications of nephrotic syndrome?

Nephrotic syndrome can be acute and have only a few symptoms, or it can be lifelong and progressive. Complications from nephrotic syndrome depend on the underlying cause of nephrotic syndrome. Complications of untreated or poorly controlled nephrotic syndrome can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of nephrotic syndrome include:

  • Ascites (abdominal fluid accumulation)

  • Atherosclerosis (buildup of plaque on the walls of the coronary arteries; atherosclerosis is a type of arteriosclerosis)

  • Chronic infection (due to impaired immunity)

  • Kidney failure

  • Malnutrition

  • Pulmonary edema

  • Renal vein thrombosis (blood clot in the veins draining blood from the kidneys)

  • Vitamin D deficiency

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 5
  1. Proteinuria. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/.
  2. Nephrotic syndrome. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001520/.
  3. Zacchia M, Trepiccione F, Morelli F, et al. Nephrotic syndrome: new concepts in the pathophysiology of sodium retention. J Nephrol 2008; 21:836.
  4. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
  5. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
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