NEPHROTIC SYNDROME (Nephrosis)

General Information

DEFINITION--A condition that results from damage to the glomeruli (the filtering units of the kidneys). It causes impaired blood to flow from the kidneys back into the body's tissues, leading to swelling throughout the body. In addition, there is an increase of salt and fluid retention, which further aggravates the situation. Nephrotic syndrome is not actually a disease, but a combination of symptoms and signs.

BODY PARTS INVOLVED--Kidneys. Late or complicated stages involve all body cells.

SEX OR AGE MOST AFFECTED--Children and adults. It affects more boys than girls.

SIGNS & SYMPTOMS

• Fluid retention (edema) that appears first as puffy eyes and ankles, then as general puffiness of the skin, and eventually as a swollen abdomen.
• Reduced urine production, sometimes to 20% of normal; frothy urine.
• Appetite loss; weakness; general ill feeling.

CAUSES--May be primary (not always possible to determine the cause) or may occur as a complication of other problems that affect kidney function, such as: diabetes; lupus erythematosus; multiple myeloma; AIDS; glomerulonephritis; autoimmune disorders; serum sickness and other severe allergic disorders; blood clot in the kidney; infections; congenital heart disease; or some medications.

RISK INCREASES WITH

• Family history of nephrotic syndrome (primary form only).
• Pregnancy.
• Exposure to chemical toxins.
• Congestive heart failure.
• Lymphoma.
• Drug addiction.
• Immunosuppression due to illness or drugs.

HOW TO PREVENT--Obtaining prompt treatment for any causes listed, especially skin and throat infections, may lessen risks.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and physical exam by a doctor. Laboratory studies, such as urinalysis and blood studies of protein and cholesterol.
• Kidney biopsy (See Glossary).

APPROPRIATE HEALTH CARE

• Home care after diagnosis.
• Doctor's treatment.

POSSIBLE COMPLICATIONS

• Kidney disease that resembles chronic glomerulonephritis; kidney failure.
• Increased susceptibility to infections.

PROBABLE OUTCOME--Medication and diet can control swelling and reverse kidney abnormalities. Although symptoms usually disappear in 2 weeks with treatment, medication is continued for 6 to 8 weeks. Nephrotic syndrome can be arrested with treatment, but relapses are common and the treatment must be repeated. If kidney failure develops, dialysis or a kidney transplant can prolong life.

How To Treat

GENERAL MEASURES--

• Parents may need counseling and help in learning to manage a chronically ill child.
• During the acute phase: Keep a record of the temperature each morning and evening. Collect all urine passed during each 24 hours and record every amount. Record all fluids consumed also. Portions of the urine may be analyzed in the doctor's office.
• Keep immunizations current, especially influenza and pneumovax.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Cortisone or immunosuppressive drugs to reduce kidney inflammation.
• Diuretics, including potassium-saving diuretics, to reduce fluid retention.
• Antibiotics to control infection.
• Supplemental vitamins and iron.

ACTIVITY--Stay in bed (except for trips to the bathroom) until the edema (fluid retention) improves. After the swelling decreases, be as mildly active as your strength allows.

DIET--

• Cook and serve food without salt. Avoid salty prepared foods. Reduce fat in the diet.
• You may need to restrict fluid intake. Ask your doctor.
• If you are overweight, try to lose weight.

Call Your Doctor If

The following occurs during treatment: Severe headache; convulsion; extreme weakness. Signs of infection, such as fever, sores on the skin, cough or burning on urination. Failure to pass 1 quart of urine in a 24-hour period. Increased fluid retention. Vomiting, diarrhea or nausea.