Nephrotic Syndrome
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is nephrotic syndrome?
Nephrotic syndrome is a group of findings caused by damage to the kidney filters, producing heavy protein loss in the urine, low blood albumin, swelling and raised cholesterol. It is a pattern rather than a single disease, and identifying the underlying cause guides treatment. It also carries a significant risk of blood clots and infection.
Causes
- Minimal change disease, the commonest cause in children
- Focal segmental glomerulosclerosis
- Membranous nephropathy
- Diabetic kidney disease
- Lupus nephritis
- Amyloidosis
- Some infections and medicines
Symptoms
- Swelling around the eyes, especially in the morning
- Swelling of ankles, legs and abdomen
- Frothy urine from heavy protein loss
- Weight gain from fluid retention
- Fatigue and reduced appetite
- Breathlessness if fluid collects around the lungs
Risk factors
- Diabetes
- Systemic lupus erythematosus
- Chronic hepatitis B or C infection
- Certain medicines including some anti inflammatories
- Family history of kidney disease
Diagnosis
- Urine protein creatinine ratio showing heavy proteinuria
- Serum albumin and lipid profile
- Kidney function tests
- Autoimmune and infection screening
- Kidney biopsy in most adults to determine the cause
Treatment
- Corticosteroids, particularly effective in minimal change disease
- Immunosuppressants for specific underlying diagnoses
- ACE inhibitors or angiotensin receptor blockers to reduce protein loss
- Diuretics and dietary salt restriction for oedema
- Statins for raised cholesterol
- Anticoagulation when clot risk is high
- Vaccination against pneumococcus given infection risk
Self care
- Reduce dietary salt to help control swelling
- Take diuretics and other medicines exactly as prescribed
- Weigh yourself daily to track fluid
- Follow any fluid restriction given
- Attend regular urine and blood monitoring
- Keep vaccinations current, especially pneumococcal
- Report any infection promptly given increased susceptibility
When to see a doctor
Book an appointment if:
- Increasing swelling or rapid weight gain
- Frothy urine returning after treatment
- Reduced urine output
- New breathlessness
- Signs of infection such as fever
- Side effects from steroids or immunosuppressants
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- The syndrome itself often cannot be prevented
- Relapses are reduced by taking treatment as prescribed
- Control diabetes and blood pressure where these are the cause
- Vaccinate against pneumococcus and influenza
- Treat infections early, since they can trigger relapse
Outlook
Outcome depends on the underlying cause. Minimal change disease, most common in children, usually responds very well to steroids with an excellent long term outlook, though relapses are common. Membranous nephropathy and focal segmental glomerulosclerosis have more variable courses, and some progress to chronic kidney disease requiring dialysis.
Common questions
Why does clotting risk increase?
Proteins that regulate clotting are lost in the urine alongside albumin, shifting the balance toward clot formation. This raises the risk of deep vein thrombosis, pulmonary embolism and renal vein thrombosis.
Is it the same as nephritic syndrome?
No. Nephrotic syndrome features heavy protein loss with swelling and low albumin. Nephritic syndrome features blood in the urine, high blood pressure and reduced kidney function with less protein loss.
Do children usually recover?
Most children have minimal change disease, which responds well to steroids and has a good long term outlook, although relapses are common and some need additional immunosuppression.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.