Nephrotic Syndrome

Nephrotic syndrome is a kidney disorder in which damage to the filtering units of the kidney causes large amounts of protein to leak into the urine, leading to widespread swelling and other characteristic features. It is more common in children but can affect adults as well.

• Swelling (oedema), often first noticed around the eyes in the morning, then in the legs and abdomen
• Frothy or foamy urine, due to high protein content
• Weight gain from fluid retention
• Fatigue and, in children, poor appetite
• Increased susceptibility to infections

• In children, most cases result from a kidney condition called minimal change disease, in which the cause is often not identifiable.
• In adults, causes include diabetes, certain infections, autoimmune conditions, and other kidney diseases.
• The underlying process is damage to the kidney's filtering membrane, allowing protein to leak into the urine.

• Diagnosed by urine testing showing heavy proteinuria, together with low blood protein (albumin) levels and characteristic swelling on examination.
• Blood tests assess kidney function and cholesterol, which is often elevated.
• Kidney biopsy may be needed in adults, or in children who do not respond as expected to initial treatment, to identify the underlying cause.

In children with a first episode, a trial of oral corticosteroid treatment (such as prednisolone) is typically started, as most respond well, particularly when the underlying cause is minimal change disease.

Fluid and salt intake are moderated to help control swelling, alongside monitoring of weight and urine output.

Diuretics may be used cautiously to help manage severe swelling under medical supervision.

Children or adults who do not respond to initial steroid treatment, who relapse frequently, or where the diagnosis is uncertain are referred to a specialist for further evaluation, which may include kidney biopsy and alternative treatments.

Prompt treatment of any infection is important, as nephrotic syndrome increases susceptibility to serious infection.

• Attend regular follow-up to monitor for relapse, especially in children with a known history of nephrotic syndrome.
• Monitor urine for recurrence of frothiness, which can signal a relapse.
• Ensure vaccinations are up to date, as advised by a health worker, given increased infection risk.
• Follow prescribed salt and fluid guidance during periods of active swelling.