Nephrotic Syndrome in Children
Idiopathic nephrotic syndrome accounts for about 90 % of children with nephrotic syndrome.
What is Nephrotic Syndrome?
Nephrotic syndrome is characterized by the following symptoms that result from changes that occur to the small, functional filters in the kidneys, such as:
Very high levels of protein in the urine
Low levels of protein in the blood due to its loss in the urine
Tissue swelling all over the body (edema) especially in the abdomen (ascites)
High cholesterol levels in the blood
Decrease in frequency of urination
Weight gain from excess fluid
What are the Different Types of Nephrotic Syndrome?
The type of nephrotic syndrome that is most common in children is called idiopathic nephrotic syndrome. It accounts for about 90 percent of children with nephrotic syndrome. Idiopathic means that a disease occurs with no known cause. The most common type of idiopathic nephrotic syndrome is called minimal-change nephrotic syndrome (MCNS). Idiopathic nephrotic syndrome is more common in boys than girls.
With MCNS, the child usually has relapses of the illness, but the disease can usually be managed and prognosis is usually good. In rare cases, a child may develop kidney failure that requires dialysis.
There is a rare nephrotic syndrome present in the first week of life called congenital nephrotic syndrome. Congenital nephrotic syndrome is inherited by an autosomal recessive gene, which means that males and females are equally affected, and the child inherited one copy of the gene from each parent, who are carriers. The chance for carrier parents to have a child with congenital nephrotic syndrome is one in four, or 25 percent, with each pregnancy. The outcome for this type of nephrotic syndrome is extremely poor.
What are the Symptoms of Nephrotic Syndrome?
- Weight gain and facial swelling
- Abdominal swelling or pain
- Foamy urine
- Fluid accumulation in the body spaces (edema)
- Fatigue and malaise
- Decreased appetite
- Pale fingernail beds
How is Nephrotic Syndrome Diagnosed?
- Urine tests. Tests to check for protein
- Blood tests. Tests to check the levels of cholesterol and a special blood protein called albumin
- Renal ultrasound. A noninvasive test in which a transducer is passed over the kidney producing sound waves which bounce off of the kidney, transmitting a picture of the organ on a video screen. The test is used to determine the size and shape of the kidney and to detect a mass, kidney stone, cyst, or other obstruction or abnormalities.
- Renal biopsy. A procedure where a small sample of tissue is taken from the kidney through a needle. The tissue is sent for special testing to determine the specific disease.
What is the Treatment for Nephrotic Syndrome?
- Your child's age, overall health, and medical history
- The extent of the disease
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
During the initial episode of nephrotic syndrome, your child may require hospitalization. He or she may need to be monitored if the edema is severe or if he or she has blood pressure and/or breathing problems.
Medications may be required to treat initial symptoms and during relapses. These medications may include:
- Immunosuppressive drug therapy
- Diuretics (to reduce the edema)
- Intravenous (IV) albumin. A blood protein that can be administered to replace the low levels
- A special diet that restricts salt and has other specifications