Nephrotic syndrome (NS) is a kidney disorder that commonly affects children. It occurs when the kidneys lose their ability to properly filter waste and excess fluids from the blood, leading to a significant leakage of protein into the urine. Understanding this condition is crucial for both parents and healthcare professionals, as early diagnosis and treatment can help manage symptoms and prevent complications.
What is Nephrotic Syndrome?
Nephrotic syndrome is identified by a combination of specific symptoms, including:
– Proteinuria: Excessive amounts of protein in the urine.
– Hypoalbuminemia: Low levels of albumin (a type of protein) in the blood.
– Oedema: Swelling, often noticeable around the eyes, abdomen, or legs.
– Hyperlipidaemia: High levels of cholesterol and other fats in the blood.
These symptoms develop because the kidneys, which usually retain essential proteins, become less efficient at filtering, leading to a loss of protein that affects the body’s fluid balance.
Causes of Nephrotic Syndrome in Children
Nephrotic syndrome can be classified as primary or secondary:
1. Primary Nephrotic Syndrome (Idiopathic):
– This form of nephrotic syndrome occurs without an identifiable underlying cause. The most common type is **Minimal Change Disease (MCD)**, where the kidneys appear nearly normal under a microscope but are still unable to properly retain protein.
2. Secondary Nephrotic Syndrome:
– This is caused by underlying conditions such as infections (e.g., hepatitis, HIV), autoimmune diseases (e.g., lupus), or side effects of certain medications. It is less common in children but can be more severe.
Risk Factors for Nephrotic Syndrome
Nephrotic syndrome can affect children at any age, though it is most common between the ages of 2 and 6. Boys are more frequently affected than girls. Certain risk factors, such as family history, infections, or medication use, may increase the likelihood of developing the condition.
Signs and Symptoms of Nephrotic Syndrome
The symptoms of nephrotic syndrome vary but may include:
– Swelling (Oedema): Puffiness around the eyes, especially in the morning, and swelling in the legs and abdomen later in the day.
– Foamy Urine: This is due to high protein levels in the urine.
– Weight Gain: Often caused by fluid retention.
– Fatigue: Resulting from the loss of proteins that help balance fluid and salt levels.
– Decreased Urine Output: Reduced frequency or smaller amounts of urine.
Diagnosis of Nephrotic Syndrome
Nephrotic syndrome is typically diagnosed through clinical examination and laboratory tests, such as:
– Urine Tests: A urine dipstick test detects high protein levels. In some cases, a 24-hour urine collection may be performed for a more accurate assessment.
– Blood Tests: These evaluate protein, cholesterol, and other blood levels.
– Kidney Biopsy: This may be recommended in more complex cases to determine the underlying cause of the syndrome.|
Treatment Options for Nephrotic Syndrome in Children
Treatment for nephrotic syndrome depends on the severity of the condition and the underlying cause. The main goal is to reduce protein loss, control swelling, and manage any underlying conditions. Common treatments include:
– Corticosteroids (Prednisolone): Steroids are the first line of treatment, especially for Minimal Change Disease. Most children respond well to this treatment, but relapses are common, requiring prolonged therapy.
– Diuretics: These medications help reduce swelling by increasing the removal of excess fluids.
– Immunosuppressants: For children who do not respond to steroids or have frequent relapses, medications such as cyclosporine or tacrolimus may be used.
– ACE Inhibitors: These help reduce protein loss in urine and protect kidney function.
– Dietary Adjustments: A low-sodium diet is often recommended to reduce swelling. Protein intake should be monitored, but excessive protein consumption is not advised.
– Regular Monitoring: Close follow-up with a paediatric nephrologist is essential to monitor kidney function, manage relapses, and prevent complications.
Complications of Nephrotic Syndrome
If left untreated or poorly managed, nephrotic syndrome can lead to several complications, such as:
– Infections: Children with nephrotic syndrome are more susceptible to infections due to protein loss, which affects immune function.
– Thrombosis: The loss of antithrombotic proteins can increase the risk of developing blood clots.
– Kidney Damage: Long-term or severe cases of nephrotic syndrome can result in chronic kidney disease or kidney failure.
– Malnutrition: Significant protein loss can lead to poor growth and nutritional deficiencies.
Preventing Relapses and Managing Nephrotic Syndrome
Most children with nephrotic syndrome recover fully with proper treatment. However, relapses can occur, particularly in idiopathic cases. It’s important to monitor symptoms closely, adhere to prescribed medications, and attend regular check-ups with healthcare providers.
Parents can help manage nephrotic syndrome by:
– Ensuring the child takes all medications as prescribed.
– Encouraging a low-sodium diet to control swelling.
– Monitoring for signs of relapse, such as swelling or foamy urine, and seeking medical advice promptly.
Conclusion
With early diagnosis and appropriate treatment, the outlook for children with nephrotic syndrome is generally positive, especially in cases of Minimal Change Disease. Most children recover fully and go on to lead normal, healthy lives, although ongoing management may be necessary to prevent relapses and complications.
Both parents and healthcare professionals play a vital role in managing the condition by staying informed, ensuring timely treatment, and maintaining regular monitoring to protect the child’s kidney health.
