Contents
What is nephrotic syndrome?
- Albuminuria—large amounts of protein in the urine. Albumin is a protein that acts like a sponge, drawing extra fluid from the body into the bloodstream where it remains until removed by the kidneys. When albumin leaks into the urine, the blood loses its capacity to absorb extra fluid from the body, causing enema.
- Hyperlipidemia—higher than normal fat and cholesterol levels in the blood
- edema, or swelling, usually in the legs, feet, or ankles and less often in the hands or face
- Hypoalbuminemia—low levels of albumin in the blood
Nephrotic syndrome results from a problem with the kidneys’ filters, called glomeruli. Glomeruli are tiny blood vessels in the kidneys that remove wastes and excess fluids from the blood and send them to the bladder as urine. As blood passes through healthy kidneys, the glomeruli filter out the waste products and allow the blood to retain cells and proteins the body needs. However, proteins from the blood, such as albumin, can leak into the urine when the glomeruli are damaged. In nephrotic syndrome, damaged glomeruli allow 3 grams or more of protein to leak into the urine when measured over a 24-hour period, which is more than 20 times the amount that healthy glomeruli allow.
What causes nephrotic syndrome?
Nephrotic syndrome can also be caused by systemic diseases, which are diseases that affect many parts of the body, such as diabetes or lupus. Systemic diseases that affect the kidneys are called secondary causes of nephrotic syndrome. More than 50 percent of nephrotic syndrome cases in adults have secondary causes, with diabetes being the most common.
What are the signs and symptoms of nephrotic syndrome?
- Weight gain
- Fatigue
- Foamy urine
- Loss of appetite
What are the complications of nephrotic syndrome?
- Loss of immunoglobulins—immune system proteins that help fight disease and infection—leads to an increased risk of infections.
- These infections include pneumonia, a lung infection; cellulitis, a skin infection; peritonitis, an abdominal infection; and meningitis, a brain and spine infection.
- Medications given to treat nephrotic syndrome can also increase the risk of these infections.
- High blood pressure, also called hypertension—A condition in which blood flows through the blood vessels with a force greater than normal
- Acute kidney injury—Sudden and temporary loss of kidney function
How is nephrotic syndrome diagnosed?
Urine tests
- Nephrotic syndrome is diagnosed when large amounts of protein are found in the urine. The blood protein albumin makes up much of the protein that is lost. The presence of albumin in the urine can be detected with a dipstick test performed on a urine sample.
- With the single urine sample, the lab measures both albumin and creatinine, a waste product of normal muscle breakdown. The comparison of the measurements is called a urine albumin-to-creatinine ratio. A urine sample containing more than 30 milligrams of albumin for each gram of creatinine may signal a problem.
- With a 24-hour collection of urine, the lab measures only the amount of albumin present.
Kidney biopsy
Though blood tests can point toward systemic diseases, a kidney biopsy is usually needed to diagnose the specific underlying disease causing the nephrotic syndrome and to determine the best treatment.
A kidney biopsy is a procedure that involves taking a piece of kidney tissue for examination with a microscope. Kidney biopsies are performed by a health care provider in a hospital with light sedation and local anaesthetic.
How is nephrotic syndrome treated?
- Medications that lower blood pressure can also significantly slow the progression of kidney disease causing nephrotic syndrome. Two types of blood pressure lowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease by reducing the pressure inside the glomeruli and thereby reducing albuminuria.
- Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretic—a medication that aids the kidneys in removing fluid from the blood—can also be useful in helping to reduce blood pressure as well as oedema.
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