Nephrotic Syndrome

Your kidneys help filter waste from your blood. Nephrotic syndrome is a problem where your kidneys let too much protein leak into your urine. This happens because tiny blood vessels inside your kidneys are damaged. This damage leads to a buildup of fluid, causing swelling, most often in your feet and ankles. Having nephrotic syndrome can also make you more likely to develop other health issues.

Nephrotic syndrome is a condition affecting the kidneys. It causes several noticeable symptoms. One of the most common is swelling, especially around the eyes, ankles, and feet. This swelling, called edema, happens because the kidneys aren't filtering fluids properly. The extra fluid causes the body to retain more water, leading to weight gain.

Another telltale sign is foamy urine. This foaminess comes from a high amount of protein leaking into the urine. Healthy kidneys usually keep protein inside the body. When protein leaks into the urine, it's a sign something is wrong with the kidney's filtering system.

You might also feel tired and have less energy (fatigue), and you may not feel like eating as much as usual (loss of appetite). These symptoms can be related to the body's fluid imbalance and the overall stress of the condition.

In short, if you notice significant swelling, foamy urine, weight gain, fatigue, or a loss of appetite, it's important to see a doctor. These could be signs of nephrotic syndrome, and early diagnosis and treatment are crucial.

If you're concerned about any health issues, schedule a visit with your doctor.

Kidney damage can cause nephrotic syndrome. Your kidneys have tiny filtering units called glomeruli. These glomeruli act like a sieve, separating useful things from waste in your blood. Healthy glomeruli stop important blood proteins, mostly albumin, from leaking into your urine. Albumin helps keep the right amount of fluid in your body. When the glomeruli are damaged, they let too much albumin leak into the urine. This protein loss is what defines nephrotic syndrome.

Several things can raise your chances of getting nephrotic syndrome, a condition that affects your kidneys.

Health Problems: Some medical issues directly harm your kidneys, making them more likely to develop nephrotic syndrome. Examples include:

• Diabetes: High blood sugar levels over time can damage the delicate filters in your kidneys.
• Lupus: This autoimmune disease, where your immune system mistakenly attacks healthy tissues, can harm your kidneys.
• Amyloidosis: A buildup of abnormal protein in your organs, including your kidneys, can disrupt their function.
• Reflux nephropathy: This happens when urine flows backward into the kidneys, causing damage over time.
• Other kidney diseases: Many other conditions, like glomerulonephritis (inflammation of the kidney's filtering units), can increase your risk.

Medications: Certain drugs can also put a strain on your kidneys and increase your risk of nephrotic syndrome. These include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Pain relievers like ibuprofen and naproxen, while helpful for many things, can sometimes harm the kidneys.
• Medications for infections: Some antibiotics and other drugs used to fight infections can have kidney-related side effects.

Infections: Some infections can increase the likelihood of nephrotic syndrome. These include:

• HIV: The human immunodeficiency virus, which causes AIDS.
• Hepatitis B and Hepatitis C: These viral infections can damage the liver and, in some cases, the kidneys.
• Malaria: This parasitic infection can also have negative effects on kidney function.

It's crucial to remember that these factors increase your risk, but they don't guarantee you'll get nephrotic syndrome. If you have concerns about your kidney health, it's essential to talk to your doctor.

Nephrotic syndrome can lead to several health problems. Here are some potential complications:

Blood Clots: Healthy blood has proteins that help prevent blood clots. Nephrotic syndrome can damage the tiny filters in your kidneys (glomeruli), causing these important proteins to leak into your urine. This leaves your blood with fewer of these clotting inhibitors, making you more likely to develop blood clots, especially in your veins.

High Cholesterol and Triglycerides: When your body loses too much of a protein called albumin (which is found in blood), your liver tries to make more. However, this process also often leads to your liver producing more cholesterol and triglycerides. These are fats that, when present in high levels, can raise your risk of heart problems.

Poor Nutrition: Losing large amounts of blood proteins can cause malnutrition. This can mean you lose weight, which might not always be noticeable because nephrotic syndrome can also cause swelling (edema). You could also develop anemia (low red blood cell count), low blood protein levels, and vitamin D deficiencies.

High Blood Pressure: Damage to the kidney filters (glomeruli) and the resulting buildup of extra fluid in your body can raise your blood pressure. High blood pressure puts added strain on your heart and blood vessels.

Acute Kidney Injury: If the kidneys lose their filtering ability due to damage from nephrotic syndrome, waste products can quickly build up in your blood. This is a serious condition requiring immediate medical attention. If this happens, you might need dialysis, a special treatment that uses a machine to remove excess fluids and waste from your blood.

Chronic Kidney Disease: Over time, nephrotic syndrome can damage your kidneys, causing them to lose function. If your kidney function significantly decreases, you may need dialysis or a kidney transplant.

Infections: People with nephrotic syndrome are more prone to infections because the condition weakens their immune system. This is because the protein loss affects the body's ability to fight off germs.

Diagnosing nephrotic syndrome often involves several tests to check for signs of kidney problems. These tests help doctors understand what's happening and create a treatment plan.

Urine Tests: One of the first things doctors do is look at your urine. A simple urinalysis can reveal if there's too much protein in your urine. Sometimes, they might ask you to collect all your urine over a full 24 hours. This gives them a better idea of the overall amount of protein being lost. High levels of protein in the urine are a key sign of nephrotic syndrome.

Blood Tests: Blood tests are also important. They can show if your blood protein levels, particularly albumin, are low. This is because nephrotic syndrome causes the kidneys to lose albumin, a vital protein. Low albumin can also lead to higher-than-normal levels of cholesterol and triglycerides in the blood. Doctors will also check your creatinine and urea nitrogen levels. These are waste products filtered out by your kidneys. High levels of these can indicate that your kidneys aren't working as well as they should.

Kidney Biopsy: In some cases, doctors might need a closer look at your kidneys. A kidney biopsy involves taking a very small piece of kidney tissue. A needle is carefully inserted into your kidney through your skin. This tissue sample is then sent to a lab for detailed examination. This test can help doctors determine the exact cause of the nephrotic syndrome. It provides more information than urine or blood tests alone.

Treating Nephrotic Syndrome: Medications and Lifestyle Changes

Nephrotic syndrome is a condition that affects the kidneys. Treatment focuses on addressing any underlying medical issues causing the syndrome and managing its symptoms and potential complications. This often involves a combination of medications and dietary adjustments.

Medications Used to Treat Nephrotic Syndrome:

• Blood Pressure Medications: High blood pressure is a common concern in nephrotic syndrome, and it can worsen kidney damage. Drugs like ACE inhibitors (angiotensin-converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) help lower blood pressure and reduce the amount of protein leaking into the urine. Examples of ACE inhibitors include lisinopril, benazepril, captopril, and enalapril. ARBs include losartan and valsartan. Sometimes, renin inhibitors are also used, but ACE inhibitors and ARBs are usually the first choices.

• Water Pills (Diuretics): These medications help the kidneys get rid of extra fluid in the body, reducing swelling (edema). Furosemide (Lasix) is a common diuretic. Other diuretics include spironolactone (Aldactone) and thiazides like hydrochlorothiazide or metolazone.

• Cholesterol-Lowering Medications (Statins): High cholesterol is another potential concern in nephrotic syndrome. Statins can help lower cholesterol levels. However, research hasn't definitively shown that statins directly improve outcomes like reducing the risk of heart attacks or death in people with nephrotic syndrome. Common statins include atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin.

• Blood Thinners (Anticoagulants): If blood clots form, blood thinners can help prevent further clotting. These are often prescribed if someone has already had a blood clot. Heparin, warfarin, dabigatran, apixaban, and rivaroxaban are examples of blood thinners.

• Immune System Suppressants: Some types of nephrotic syndrome are related to inflammation in the kidneys, triggered by the immune system. Immune system-suppressing medications, such as corticosteroids (powerful anti-inflammatory drugs), rituximab, cyclosporine, and cyclophosphamide, can help reduce this inflammation. These are typically used when other treatments haven't been enough.

Important Note: The specific medications and treatment plan will vary greatly depending on the individual's specific condition, the cause of the nephrotic syndrome, and overall health. It's crucial to discuss treatment options with a doctor to determine the best course of action. Your doctor will consider factors like your age, other health conditions, and the severity of your nephrotic syndrome when creating a personalized treatment plan.

Kidney health can be improved through dietary changes in nephrotic syndrome. Your doctor might suggest working with a registered dietitian. They can create a personalized eating plan to manage your condition. Here are some general dietary guidelines that might be part of that plan:

• Choose protein wisely: Lean proteins, like fish, poultry without skin, and beans, are good choices. Plant-based protein sources, such as lentils and tofu, are particularly helpful for kidney health. Avoid eating too much protein, as this can put extra stress on your kidneys.
• Manage fats and cholesterol: Lowering the amount of fat and cholesterol in your food helps control your blood cholesterol levels. This includes limiting foods high in saturated and trans fats, like red meat, fried foods, and some dairy products. Choose healthier fats like olive oil and avocados instead.
• Limit salt intake: A low-salt diet can help reduce swelling (edema) often associated with nephrotic syndrome. This means avoiding processed foods, canned goods, and salty snacks. Read food labels carefully to see how much sodium is in each item.
• Control fluid intake: Your doctor may advise you to limit the amount of liquid you drink. This is because excess fluid can worsen swelling. This doesn't mean you need to go without fluids completely, but it does mean you should follow your doctor's guidance on how much is appropriate for you.

These dietary changes can help manage nephrotic syndrome symptoms and support overall kidney health. It's crucial to discuss your specific dietary needs with your doctor and registered dietitian for personalized recommendations.