What is Nephrotic Syndrome ?
Malli has lost interest in going out to play since last 2 weeks. She prefers to sit at home and play with her toys. Her parents have noticed swelling over her eyes when she gets up in the morning. They took her to an eye doctor who found nothing wrong with her eyes. He asked them to consult a child specialist.
Malli’s parents took her to a child specialist who asked for a urine test. The urine test showed proteins +++. The child specialist told them that Malli had a kidney disease called nephrotic syndrome. Malli’s parents were very anxious. They had a lot of questions. What is nephrotic syndrome? Why does it happen? Has Malli’s kidneys failed?? Malli’s father”s colleague had a kidney disease and his doctor had done a kidney biopsy. Will Malli also need one? Her doctor answered all their questions.
Swelling over the eyes.
More in the morning
Nephrotic syndrome is one of the commonest kidney diseases seen in children.It usually starts between two to seven years of age. This is a condition in which the filters in the kidney get leaky and proteins present in the blood leak into the urine. Normally proteins should not leak into the urine as proteins are needed by the body for growth and good health. The proteins in the urine makes it look bubbly and frothy. On testing, the urine shows the presence of proteins. The laboratory will report this as Proteins ++ or +++.
There are many different kinds of proteins in the blood .The main protein lost in the urine in nephrotic syndrome is Albumin leading to low levels of Albumin in the blood. This causes water accumulation in the body. The water accumulation is seen as swelling that is initially seen over the eyes in the mornings. Later, the swelling may be seen over the feet and over the abdomen. In severe cases, there will be swelling all over the body and the child may pass less urine. Additional blood tests are needed to confirm the diagnosis.
Small holes in normal kidney filters.
Large leaky holes in nephrotic kidney filters
This disease requires treatment with a special type of medication called steroids. Steroids will stop the protein leak in most children within two to four weeks. The treatment continues for two to three months even after the protein leak stops in order to help the kidney heal fully. As steroids are strong medications, there can be side effects when they are taken for a long time. Therefore, regular check-ups are needed to make sure that the child has responded to the treatment and does not have side effects.
Many children with this disease tend to develop protein leak again at sometime or the other after steroids are stopped. This is called a relapse. Parents need to watch out for relapses and get it treated promptly. Relapses can be recognized early by doing urine test for proteins at home. The test is very simple and can be easily done by parents [How to do home testing for urine proteins]. In spite of several relapses, most children who respond well to steroids will eventually outgrow the disease between 12 to 15 years of age and will not go into kidney failure.
Kidney biopsy is a special test done in some cases of nephrotic syndrome. It may be needed in some children with nephrotic syndrome who do not respond to steroids and whose urine protein leak continues in spite of giving the right dose of steroids for more than a month. The kidney biopsy is a procedure where a small thread-like piece of kidney is taken for special tests. This helps the doctor to understand what is happening inside the kidney and to decide on further treatment
Urine has lots of bubbles and looks frothy
Most children with nephrotic syndrome will respond well to steroids and will not need a kidney biopsy. Malli may not need this test.