Nephrotic syndrome diagnosis

In most cases, the cause is not known. However, a number of conditions can damage the glomeruli and cause nephrotic syndrome. In children, the most common cause is due to minimal change disease. The cause of minimal change disease isn't known, but it can be related to infections, tumors, allergic reactions, and overuse of over-the-counter medications like ibuprofen and acetaminophen. Most children outgrow minimal change disease by the time they are in their teens. Other conditions can damage the glomeruli, including other kidney conditions, immune system problems, infections, or diseases like cancer and diabetes. In certain cases, an allergic reaction to food or the use of certain legal and illegal drugs, or obesity can lead to nephrotic syndrome. You may see swelling around your child's eyes in the morning. Often, that's the first sign. As time passes, the swelling may last all day, and you may see swelling in your child's ankles, feet or belly. Also, your child may: • be more tired • be more irritable • have a decreased appetite • look pale. Your child may have trouble putting on shoes or buttoning clothes because of swelling. Your child's doctor will check for symptoms, such as swelling and pale skin. In addition, a urine test can check for the amount of protein, blood and other things to look for kidney damage. A blood test can show how well your child's kidneys are working. The doctor will also check for other diseases that may be causing the nephrotic syndrome. In so...

Nephrotic syndrome is characterized by the following: • a high amount of protein present in the urine (proteinuria) • high cholesterol and triglyceride levels in the blood ( • low levels of a protein called albumin in the blood ( • swelling ( In addition to the above symptoms, people with nephrotic syndrome may also experience: • • weight gain from fluid buildup in the body • • Your Nephrotic syndrome happens when the glomeruli are damaged and can’t properly filter your blood. Damage to these blood vessels allows protein to leak into your urine. Albumin is one of the proteins lost in your urine. Albumin helps pull extra fluid from your body into your kidneys. This fluid is then removed in your urine. Without albumin, your body holds on to the extra fluid. This causes swelling (edema) in your legs, feet, ankles, and face. Primary causes of nephrotic syndrome Some conditions that cause nephrotic syndrome only affect the kidneys. These are called primary causes of nephrotic syndrome. These conditions include: • Focal segmental glomerulosclerosis (FSGS). This is a condition in which the glomeruli become scarred from disease, a genetic defect, or an unknown cause. • Membranous nephropathy. In this disease, the membranes in the glomeruli thicken. The cause of the thickening isn’t known, but it may occur along with lupus, hepatitis B, malaria, or cancer. • Minimal change disease. For a person with this disease, kidney tissue looks normal under a microscope. But for some unknown r...

Nephrotic syndrome may be caused by primary (idiopathic) renal disease or by a variety of secondary causes. Patients present with marked edema, proteinuria, hypoalbuminemia, and often hyperlipidemia. In adults, diabetes mellitus is the most common secondary cause, and focal segmental glomerulosclerosis and membranous nephropathy are the most common primary causes. Venous thromboembolism is a possible complication; acute renal failure and serious bacterial infection are also possible, but much less common. There are no established guidelines on the diagnostic workup or management of nephrotic syndrome. Imaging studies are generally not needed, and blood tests should be used selectively to diagnose specific disorders rather than for a broad or unguided workup. Renal biopsy may be useful in some cases to confirm an underlying disease or to identify idiopathic disease that is more likely to respond to corticosteroids. Treatment of most patients should include fluid and sodium restriction, oral or intravenous diuretics, and angiotensin-converting enzyme inhibitors. Some adults with nephrotic syndrome may benefit from corticosteroid treatment, although research data are limited. Intravenous albumin, prophylactic antibiotics, and prophylactic anticoagulation are not currently recommended. In nephrotic syndrome, a variety of disorders cause proteinuria, often resulting in marked edema and hypoalbuminemia. Hyperlipidemia is a common associated finding. Family physicians may encount...

Nephrotic syndrome (NS) consists of peripheral edema, heavy proteinuria, and hypoalbuminemia, often with hyperlipidemia. Patients typically present with edema and fatigue, without evidence of heart failure or severe liver disease. The diagnosis of NS is based on typical clinical features with confirmation of heavy proteinuria and hypoalbuminemia. The patient history and selected diagnostic studies rule out important secondary causes, including diabetes mellitus, systemic lupus erythematosus, and medication adverse effects. Most cases of NS are considered idiopathic or primary; membranous nephropathy and focal segmental glomerulosclerosis are the most common histologic subtypes of primary NS in adults. Important complications of NS include venous thrombosis and hyperlipidemia; other potential complications include infection and acute kidney injury. Spontaneous acute kidney injury from NS is rare but can occur as a result of the underlying medical problem. Despite a lack of evidence-based guidelines, treatment consisting of sodium restriction, fluid restriction, loop diuretics, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, and careful assessment for possible disease complications is appropriate for most patients. Renal biopsy is often recommended, although it may be most useful in patients with suspected underlying systemic lupus erythematosus or other renal disorders, in whom biopsy can guide management and prognosis. Immunosuppressive tre...

What is nephrotic syndrome? Nephrotic syndrome causes scarring or damage to the filtering part of the kidneys (glomeruli). This causes too much protein to be lost from the blood into the urine. People with nephrotic syndrome often have: • Very high levels of protein in the urine (proteinuria) • Low levels of protein in the blood (hypoalbuminemia) • Swelling (edema), especially around the eyes, feet, and hands • High cholesterol What causes nephrotic syndrome? Nephrotic syndrome results from damage to the kidneys' glomeruli. These are the tiny blood vessels that filter waste and excess water from the blood and send them to the bladder as urine. Your glomeruli keep protein in the body. When they are damaged, protein leaks into the urine. Healthy kidneys allow less than 1 gram of protein to spill into the urine in a day. In nephrotic syndrome, the glomeruli let 3 grams or more of protein to leak into the urine during a 24-hour period. Nephrotic syndrome may happen with other health problems, such as kidney disease caused by diabetes and immune disorders. It can also develop after damage from viral infections. The cause of nephrotic syndrome is not always known. What are the symptoms of nephrotic syndrome? Nephrotic syndrome is a set of symptoms. These are the most common: • High blood pressure • Swelling in the feet and hands, and around the eyes • Weight gain with fluid retention and swelling • Signs of infection such as fever, or an elevated white blood cell count • Swellin...

Key points • Nephrotic syndrome is a clinical disorder characterised by heavy proteinuria, hypoalbuminaemia and oedema • Idiopathic Nephrotic Syndrome (INS) is the commonest type; any child with atypical features should have an early referral to nephrology • The key acute complications are hypovolemia, infection and thrombosis • Discharge education is crucial with the first presentation due to the high risk of relapse Background • 90% of nephrotic syndrome is idiopathic • Secondary causes such as Systemic Lupus Erythematosus (SLE) or Henoch Schonlein Purpura (HSP) should be considered if there are atypical features • 80-90% of cases of Idiopathic Nephrotic Syndrome (INS) are steroid sensitive and respond to initial therapy • Of the children with steroid-sensitive Nephrotic Syndrome 80% will have one or more relapses Nephrotic Syndrome usually presents with the classic triad of oedema, proteinuria and hypoalbuminaemia. Oedema can be non-dependant eg periorbital. Consider other causes of generalised oedema eg liver disease, congestive cardiac failure and protein losing enteropathy. Assessment of severity and complications: • Intravascular volume depletion (although children are invariably oedematous, they can be concurrently intravascular volume deplete): • dizziness, abdominal cramps • peripheral hypoperfusion (cold hands or feet, mottling, capillary refill time >2 seconds) • tachycardia, reduced urine output, hypotension (late sign) • Severe or symptomatic oedema: • discom...

Who is at risk for nephrotic syndrome? Anyone can get nephrotic syndrome, but it is slightly more common in men than in women. In children, it happens most often between the ages of two and six. There are other factors that may increase your risk. You are more likely to get nephrotic syndrome if you: • Have a disease that affects the kidneys such as FSGS, lupus or diabetes • Take certain medicines like nonsteroidal anti-inflammatory drugs (NSAIDS) or antibiotics • Have an infection such as HIV, hepatitis B and C or malaria What are the symptoms of nephrotic syndrome? You may not know that you have nephrotic syndrome until you have routine blood and Signs of nephrotic syndrome that you may notice are: • Swelling in your legs, feet, ankles and sometimes face and hands • Weight gain • Feeling very tired • Foamy or bubbly urine • Not feeling hungry What causes nephrotic syndrome? Nephrotic syndrome happens when you have a disease that damages the filters in your kidneys causes them to not work as they should. There are primary and secondary causes of nephrotic syndrome. Primary causes of nephrotic syndrome are diseases that affect only the kidneys. The most common primary cause of nephrotic syndrome in adults is a disease called focal segmental glomerulosclerosis (FSGS) . The only way to know for sure whether you have FSGS is to get a kidney biopsy . Even when treated, most people with FSGS will eventually develop kidney failure and will need to start dialysi s or have a kidne...