Nephrotic Syndrome

This is a kidney disorder in which the tiny filtering units in the kidney (the glomeruli) are damaged. This impairs the kidneys' ability to filter and excrete waste products and water into the urine. Protein escapes into the urine instead of recirculating back into the bloodstream, causing a protein deficiency. Fluid is retained in the body's tissues because of the low blood protein. The urine volume is reduced and the body becomes swollen.

The cause of nephrotic syndrome is often obscure. If diagnosed and treated early, the disease usually resolves over time, although in rare cases it can become chronic.

WHEN SHOULD I SUSPECT THAT MY CHILD HAS NEPHROTIC SYNDROME?
The signs and symptoms of nephrotic syndrome develop gradually over a period of days or weeks. The first symptom may be weight gain, which a parent can easily misinterpret as a sign of normal growth. It is actually due to water retention, which soon causes puffiness around the eyes, followed by swelling of the face, abdomen and ankles. Urine output decreases by as much as 80 percent; the urine looks dark and frothy. The child may be lethargic and have a poor appetite but, overall, may not seem very ill.

WHAT CAUSES NEPHROTIC SYNDROME?
In most cases, the cause is unknown. The syndrome is frequently preceded by an illness such as an upper respiratory infection, but these infections are thought to trigger the syndrome, not cause it. In a few children, nephrotic syndrome may be due to drug reaction or to an underlying disease, such as diabetes mellitis or lupus.

IS MEDICAL ATTENTION NECESSARY?
Yes. A child with nephrotic syndrome is susceptible to a variety of serious infections, including pneumonia, peritonitis and bloodstream infection. In rare cases, persistent nephrosis can lead to kidney failure.

HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS NEPHROTIC SYNDROME?
The physician will examine the child, take a medical history and order blood and urine studies. If the child has nephrotic syndrome, the urine will contain high levels of protein, while the blood will show a protein deficiency. In rare cases, your doctor may recommend a renal biopsy, in which a small amount of tissue is extracted from the kidney through a needle and then examined in a laboratory.

WHAT TREATMENTS ARE AVAILABLE?
The child will probably be hospitalized and placed on a diet high in protein and low in salt and fluids. Initially, high doses of steroids may be prescribed to lower the amount of protein in the urine and encourage remission of the syndrome. Steroids have significant side effects, though, and will be tapered off gradually. The bloating caused by fluid retention can be reduced with diuretic drugs. Your child may be given antibiotics to fight off any infections during this vulnerable period.

If caught early, the syndrome may be cured within weeks. However, relapses are common. In these cases, treatment must be resumed over the course of months or even years. In most children, continued treatment eventually eliminates the disease with no harmful effects.

RECOGNIZING NEPHROTIC SYNDROME
The following group of signs and symptoms are characteristic of nephrotic syndrome:

• Generalized bloating (edema)

• Swelling of the face, abdomen, legs and genitals

• Decreased amount of urine

• Dark, frothy urine

• Diarrhea and lack of appetite

• Malnutrition due to loss of protein and lack of appetite

• Respiratory difficulties due to pulmonary edema

• Pale skin, fatigue

• Increased susceptibility to infection

GETTING HELP
Call your doctor if your child:

• Is bloated and has dark urine or any other signs of nephrotic syndrome

• Has been previously diagnosed with nephrotic syndrome and shows any signs of an infection or relapse

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.