Nephrotic Syndrome - Symptoms, causes and treatment

Nephrotic syndrome is damage to the kidneys that causes protein levels in the urine to increase. The high level of protein is caused by a leak in the part of the kidney that functions to filter blood (glomerulus)

Nephrotic syndrome is a type of kidney disease in children and adults. This condition that attacks the urinary system can be treated by taking the drugs prescribed by the doctor.

If nephrotic syndrome is caused by another disease, such as diabetes or lupus, the doctor will also treat the condition causing the nephrotic syndrome.

Nephrotic Syndrome Causes

Nephrotic syndrome occurs due to damage to the glomerulus, which is the part of the kidney that functions to filter blood and produce urine. As a result, proteins that should remain in the blood leak into the urine. Under normal conditions, urine does not contain protein.

Nephrotic syndrome is divided into two types, namely primary nephrotic syndrome and secondary nephrotic syndrome. In primary nephrotic syndrome, the glomerulus undergoes changes in the form of thickening or the formation of scar tissue so that it cannot function normally. However, it is not known exactly why this change occurred.

Meanwhile, secondary nephrotic syndrome occurs due to other diseases that cause damage to the kidneys. Some of the diseases that can cause secondary nephrotic syndrome are:

• Diabetes
• Lupus
• Infectious diseases, such as leprosy, syphilis, HIV, malaria, or hepatitis B and hepatitis C
• Henoch-Schonlein purpura
• Rheumatoid arthritis
• Amyloidosis
• Cancer, such as leukemia or lymphoma
• Sjogren's Syndrome
• Erythema multiforme

In addition to some of the diseases above, the consumption of drugs that affect the work of the kidneys, such as non-steroidal anti-inflammatory drugs or interferon alpha, can also increase a person's risk of developing nephrotic syndrome. Heroin abuse is also at risk for nephrotic syndrome.

Nephrotic Syndrome Symptoms

The main symptom of nephrotic syndrome is a buildup of fluid in the body or edema. Edema occurs due to low protein in the blood.

One of the functions of protein in the blood is to hold fluid in the blood. If the protein level is low, fluid from the blood vessels will leak out and accumulate in body tissues.

In children, edema caused by nephrotic syndrome can be observed from swelling in the face. While in adults, edema can be seen from swelling in the heel followed by swelling in the calves and thighs.

Other symptoms of nephrotic syndrome that can appear are:

• Foamy urine due to protein in urine
• Diarrhea
• Nausea
• Tired, lethargic, and lost appetite
• Weight increases due to accumulation of body fluids

Nephrotic syndrome caused by other diseases will also cause the above symptoms and specific symptoms of the disease causing it. For example, nephrotic syndrome caused by rheumatoid arthritis will be accompanied by symptoms of joint pain.

When to see a doctor

If you suffer from lupus or diabetes, follow the treatment recommendations from your doctor and continue to have regular check-ups even if they are no longer causing symptoms. Both diseases require long-term treatment.

Go to the doctor immediately if you experience symptoms of nephrotic syndrome, such as edema followed by foamy urine, so that you get a doctor's examination and help. This needs to be done because untreated nephrotic syndrome can lead to chronic kidney failure that is permanent.

Nephrotic Syndrome Diagnosis

At the initial examination, the doctor will ask the patient's symptoms and medical history, followed by examining the patient's physical condition. In pediatric patients, the doctor will also ask his family whether any family members have suffered from the disease.

If from the initial examination the doctor suspects that the patient has nephrotic syndrome, a further examination will be carried out, which includes:

Urine test

The urine sample will be examined in the laboratory to see if there is protein leaking. The doctor can ask the patient to take a urine sample for a full 24 hours.

Blood test

The doctor will take a sample of the patient's blood to check the level of protein in the blood (albumin), along with kidney function tests. Blood tests can also be done to find out the cause of nephrotic syndrome, such as a blood sugar test for people with diabetes.

Kidney biopsy

This procedure is used to take a sample of tissue from the kidney. A kidney biopsy is performed to examine kidney tissue through a microscope.

Nephrotic Syndrome Treatment

The treatment of nephrotic syndrome by a kidney doctor depends on the cause. There are several drugs that can be given to people with nephrotic syndrome, including:

1. Corticosteroid drugs

This drug is used to treat inflammation of the kidneys or treat inflammatory diseases that cause nephrotic syndrome, such as lupus or amyloidosis. An example of this drug is methylprednisolone.

2. Antihypertensive drugs

This drug works to lower blood pressure which can increase when kidney damage occurs. High blood pressure medications can also reduce the amount of protein that is excreted in the urine. Examples of these drugs are ACE inhibitors, such as enalapril or catropril.

3. Diuretic drugs

The function of diuretic drugs is to remove excess fluid from the body so that it can reduce the symptoms of edema. An example of a diuretic drug is furosemide.

4. Blood thinners

The function of this drug is to reduce the risk of blood clots that are a complication of nephrotic syndrome. An example of this drug is heparin.

5. Penicillin

Penicillin is an antibiotic drug that is used to prevent infection which is a complication of nephrotic syndrome.

If the protein in the blood is too low, the doctor can give albumin through an IV. Doctors will also advise patients to undergo kidney transplantation or dialysis if they have chronic kidney failure.

Patient's diet also needs to be adjusted. Patients need to consume adequate protein, no more or less. In addition, patients need to reduce s alt, fat, and cholesterol consumption to prevent complications and reduce edema. Consult a nutritionist regarding the diet for patients with nephrotic syndrome.

The rate of recovery from this condition is highly dependent on the cause, severity, and the body's response to treatment. Generally, childhood sufferers can recover, although 70% of them will experience it again in the future.

Nephrotic Syndrome Complications

Nephrotic syndrome that is not treated properly can lead to complications, such as:

• Hypertension due to kidney disorders
• Low albumin levels (hypoalbuminemia) and anasarca edema due to the large amount of albumin protein in the blood that is wasted with urine
• Increased cholesterol and triglyceride levels in the blood
• Formation of blood clots due to natural blood-thinning proteins being wasted with urine, so there is a risk of causing blockages in the veins
• Vulnerable to infection due to antibodies in the blood being wasted with urine
• Acute kidney failure or chronic kidney failure due to the kidneys not being able to filter blood optimally

Nephrotic Syndrome Prevention

Nephrotic syndrome of unknown cause (primary nephrotic syndrome) is difficult to prevent. However, nephrotic syndrome that occurs due to other diseases can be prevented by treating the underlying disease.

For example, diabetics need to take blood sugar control medication from their doctor, and follow the diet and exercise recommended by the doctor.

The next step that is equally important is to prevent complications of nephrotic syndrome, one of which is kidney failure due to permanent damage to the kidneys. This can be done by undergoing treatment as recommended by a kidney doctor, as well as discipline in implementing the diet recommended by a nutritionist.