Nephrotic Syndrome: Unveiling Diagnosis & Care

Nephrotic Syndrome is a complex kidney disorder that can affect people of all ages. It is characterised by a set of symptoms and laboratory findings that can be challenging to diagnose and manage. In this blog post, we will demystify Nephrotic Syndrome by discussing its diagnosis and management strategies.

Understanding Nephrotic Syndrome

Nephrotic Syndrome is not a single disease but rather a group of symptoms that occur when the kidneys filter too much protein into the urine, leading to various complications. Massive proteinuria alone is sufficient to define this syndrome, since this finding represents serious renal disease and other components of the syndrome are actually consequences of proteinuria. The primary components of Nephrotic Syndrome include:

• Massive proteinuria ( 3.5g/day ) 
• Hypoalbuminemia ( albumin <3g% ) 
• Pitting oedema, facial puffiness
• Hyperlipidaemia and lipiduria
• Coagulopathy ( hyper-coagulable state ) 

Causes Of Nephrotic Syndrome

A wide variety of disease processes including immunological disorders, toxic injuries, metabolic abnormalities, biochemical defects and vascular disorders involving glomeruli contribute to massive proteinuria in the nephrotic range.  Common causes of nephrotic syndrome include : 

Primary glomerular diseases 

• Minimal change disease
• Membranous Nephropathy
• Mesangioproliferative glomerulonephritis
• Focal glomerulosclerosis

Secondary Causes

• Diabetes mellitus
• Amyloidosis
• Secondary syphilis 
• Lepromatous leprosy
• Kidney diseases
• Drugs like gold, mercury, captopril, antitoxins etc.

Genetic Causes

• Genetic mutations can lead to inherited forms of Nephrotic Syndrome, such as congenital nephrotic syndrome.
• Family history of kidney disorders may increase the risk of developing Nephrotic Syndrome.

Miscellaneous

• Toxaemia of pregnancy
• Reno-vascular hypertension

Recognizing the Telltale Symptoms of Nephrotic Syndrome

The earliest manifestations of nephrotic syndrome is puffiness of eyelids or periorbital oedema especially in the morning on awakening followed by oedema face. Other common symptoms include : 

• Foamy urine, a result of excess protein in your urine
• Loss of appetite
• High blood pressure
• Abnormal pain
• Feeling unwell
• Weight gain due to fluid retention
• Not feeling hungry

Diagnosis Of Nephrotic Syndrome

Diagnosing Nephrotic Syndrome involves a combination of clinical evaluation, laboratory tests, and kidney biopsy in some cases. Here are some common investigations : 

• • Urine examination reveals proteinuria and casts, haematuria is uncommon. 
  • 24 hours urine shows excretion of albumin or protein more than 3.5 g/day.
  • Serum lipids show increased LDL and cholesterol.
  • A blood test can show low levels of the protein albumin and often decreased levels of blood protein overall.
  • Renal biopsy is often done to know the nature of the underlying cause. 
  • Ultrasound of the abdomen may show normal, small or large kidneys depending on the underlying cause. 
  • Other tests to determine the underlying cause are serum complement levels, serum and urine protein electrophoresis. 

Treatment Options 

Patients are advised to take a low sodium diet usually 1 to 2g/day. If blood urea is normal, the patient is encouraged to take a good protein diet. Other treatment options include : 

Medications 

Depending on the underlying cause, medications like corticosteroids, immunosuppressants, and ACE inhibitors may be prescribed to reduce proteinuria, control blood pressure, and manage inflammation.

Diuretics

These drugs help reduce edema by promoting the excretion of excess fluid and salt from the body.

Control of proteinuria

The daily total protein intake should replace urinary protein losses to avoid negative nitrogen balance. Protein should not be restricted unless GRF falls to <25 ml/min. 

Control of infection

Sepsis is a major cause of death in NS. Pneumococcal infection is common, hence, pneumococcal vaccine should be given to patients.  Early detection and aggressive antibiotic therapy rather than prophylaxis is the best approach. 

Immune System Modulators

In some cases, therapies targeting the immune system, such as rituximab or plasmapheresis, may be considered.

Complications Management

Monitoring and treating complications like infections, blood clots, and hypertension are essential in managing nephrotic syndrome.

Kidney-Friendly Foods: What to Include in Your Diet

Diet plays a crucial role in managing nephrotic syndrome, as it can help reduce symptoms, control complications, and support overall kidney health. Here are dietary recommendations for individuals with nephrotic syndrome:

Protein intake – The amount of protein a patient eats depends on how healthy the patient’s kidneys are. Depending on your specific condition, your healthcare provider may recommend adjusting your protein intake. Typically, moderate protein consumption is recommended, but the amount may vary. High-quality protein sources like lean meats, poultry, fish, eggs, and dairy products are preferable. Plant-based options like beans, tofu, and legumes can also be included.

Salt intake – Reducing sodium (salt) in the diet is essential to manage edema (swelling) and high blood pressure. Aim for less than 2,000-2,400 milligrams of sodium per day. Avoid processed and packaged foods, canned soups, and salty snacks.

Fluid management – Fluid intake may need to be restricted if you have severe oedema or if your urine output is reduced. Your healthcare provider will provide specific guidelines based on your individual needs.

Avoid smoking and alcohol – Alcohol can interact with medications and worsen kidney function, while smoking can further damage blood vessels and the kidneys. Quitting both is strongly advised.

Remember that dietary recommendations for nephrotic syndrome can vary depending on the underlying cause and individual factors.

Conclusion

Nephrotic syndrome may seem daunting, but with the right diagnosis and management strategies, patients can effectively cope with this condition. Early detection, personalised treatment plans, and ongoing medical supervision are vital to improving the quality of life for those living with nephrotic syndrome. If you or someone you know is facing this diagnosis, consulting with a healthcare professional is the first step toward effective management and a healthier future.