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Nephrotic Syndrome In Children: Symptoms, Causes, And Treatment

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Nephrotic syndrome is a kidney condition that affects 16 out of every 100,000 children. The primary symptom of this condition is proteinuria, wherein large amounts of protein from the body are leaked into the urine. The loss of proteins from the body can cause various complications, such as infections, obstruction in the blood vessels, and acute kidney injury (1).

Each kidney consists of a network pf tiny blood vessels called the glomerulus that helps filter out harmful substances from the blood. When a child has nephrotic syndrome, the glomerulus stops working.

Most children may outgrow this kidney condition by the time they reach early adulthood. However, until then, this condition can be managed with medications. Although the prognosis for the condition is quite good, in some rare cases, the child’s kidneys might fail and require dialysis.

Read this post to understand the symptoms, causes, and treatment options for nephrotic syndrome in children.

Symptoms Of Nephrotic Syndrome In Children

The common symptoms of nephrotic syndrome in children include (2):

  • Frothy urine
  • Less urine output
  • Swelling of the body
  • Blood in urine
  • Loss of appetite
  • Diarrhea
  • High blood pressure
  • Fever and infections
  • Lethargy and irritability
  • Abdominal pain
  • Pale fingernails and dull hair
  • Food intolerances or allergies 

Types And Causes Of Nephrotic Syndrome In Children

Nephrotic syndrome in children can be categorized into primary childhood nephrotic syndrome and secondary childhood nephrotic syndrome based on the causes. Let us have a look at both in detail.

Primary childhood nephrotic syndrome

Studies have found that certain genetic changes and specific diseases may be linked to primary childhood nephrotic syndrome in children. These diseases include (2) (3)

  1. Minimal change disease. It is characterized by minute damage of the glomerulus. The damage can be seen only through a microscope. The exact cause for this disease is unknown.
  1. Focal segmental glomerulosclerosis. In this condition, some segments of an entire glomerulus get scarred. It affects only some of the glomeruli in the kidney.
  1. Membranoproliferative glomerulosclerosis. In this condition, antibodies build up in the glomeruli, resulting in thickening and damage.

Secondary childhood nephrotic syndrome

Secondary nephrotic syndrome in children is caused by an underlying disease or infection. The following are the common causes.

  • IgA vasculitis, a condition in which the small blood vessels in the body become inflamed and leak blood
  • Human immunodeficiency virus (HIV), which alters the body’s immune system, thus causing damage to the kidneys
  • Lupus, wherein the body attacks its own immune system
  • Diabetes, a condition wherein the body cannot use the glucose effectively
  • Hepatitis, which causes inflammation of the liver
  • Untreated bacterial infections, such as strep throat

Overuse of certain medications such as aspirin or other nonsteroidal anti-inflammatory drugs and exposure to chemicals such as mercury and lithium may also cause secondary childhood nephrotic syndrome in children.

Risks And Complications Of Nephrotic Syndrome

Studies predict that there could be a link between genetics and nephrotic syndrome. So, children who have a family history of kidney issues or other autoimmune diseases are at a higher risk of developing this condition. Also, children who are under certain medications or have infections could be at a higher risk.

As nephrotic syndrome affects the kidneys, children with this condition may develop the following complications (2) (4) (5) (6).

  • The low protein levels may cause a reduction in the flow of water from the tissues into the blood vessels, resulting in the accumulation of water in the tissues and further leading to swelling around the eyes, lower legs, and the rest of the body.
  • Your child will be prone to infections, as their body lacks the essential proteins that help fight the infections.
  • Unexplained weight gain is also seen due to the accumulation of excess water in the body.
  • As the essential proteins needed for preventing blood clotting are passed in the urine, children with nephrotic syndrome may experience blood clots. This is characterized by swelling and sore arms or legs, and red or pale skin.
  • As albumin leaks into the urine, the liver may produce more albumin to make up for the low levels, leading to high blood cholesterol levels. The child may also suffer from anemia due to excessive loss of iron, transferrin, erythropoietin, transcobalamin, and metals.
  • Children with nephrotic syndrome may suffer from malnutrition due to the body’s inability to absorb nutrients.
  • There is a high chance of developing coronary heart disease.
  • Children may develop mild hypothyroidism.

Diagnosis Of Nephrotic Syndrome In Children

Your doctor may first do a physical examination to check for swelling, pale fingernails, and dull hair. They may then enquire about the child’s medical and family history. To confirm the condition, the doctor may recommend a urine test to detect proteins in urine.

Blood tests to identify the low protein levels may also be required. Renal ultrasound or a renal biopsy may be done if the above tests fail to provide the diagnosis.

Treatment For Nephrotic Syndrome In Children

The main treatment option includes steroid therapy. The doctor may also prescribe additional medications to prevent the complications (3) (7).

Primary nephrotic syndrome

The main medications include those that control the immune system, remove extra fluid, and lower blood pressure.

  • The doctor may prescribe corticosteroids that help reduce the immune system’s activity, decrease the loss of proteins from the body, and decrease swelling. Up to 90% of children on daily corticosteroids achieve remission within two to three months. However, if your child does not respond to the treatment, talk to your doctor.
  • Sometimes, the doctor may prescribe a diuretic to remove the extra fluid from the body and additional medications to lower their blood pressure.

Secondary nephrotic syndrome

Secondary nephrotic syndrome can be treated when the underlying issue is addressed. The treatment options may include

  • Giving medications for bacterial infections.
  • Adjusting the dose for diabetes, lupus, and HIV.
  • Identifying and stopping medications that might cause the condition

In the case of congenital nephrotic syndrome, medications may not be effective. Most babies with congenital nephrotic syndrome would need a kidney transplant within the age of two to three years. Until then, the doctor might prescribe medications to help the kidney function. 

Special Dietary Requirements For Children With Nephrotic Syndrome

If your child is diagnosed with nephrotic syndrome, it is important to make some changes to their diet. Your doctor may advise you to cut down your child’s intake of sodium, fluid, and foods rich in saturated fats and cholesterol.

It is not easy for a child to follow a strict diet. Thus, here are a few tips to help you and your child.

  • Keep track of their daily fluid intake. Try giving them small amounts of water throughout the day.
  • Find alternative foods that are low in sodium and include them in your child’s diet.
  • Talk to your pediatrician or dietician to determine how much sodium per day is allowed.
  • Give your child a piece of frozen fruit or a lemon wedge to quench their thirst.
  • Instruct your child to stay indoors to avoid thirst.
  • Do not keep salt at the table and limit its usage in your child’s food.
  • Always prefer to serve home-cooked meals using fresh ingredients (8).

Managing nephrotic syndrome can be challenging. So, make sure you have complete information regarding your child’s condition. It is advisable to talk to your pediatrician and clear all your doubts. Often, children respond well to medications, and some of them outgrow the problem as they enter adolescence.

References:

1. Chia-shi Wang et al.; Childhood Nephrotic Syndrome Management and Outcome: A Single-Center Retrospective Analysis; International Journal of Nephrology (2017).
2. Nephrotic Syndrome (Kidney Disease) Symptoms & Causes; Boston Children’s Hospital
3. Childhood Nephrotic Syndrome; National Institute of Diabetis and Digestive and Kidney Diseases
4. Franca Iorember and Diego Aviles; Anemia in nephrotic syndrome: approach to evaluation and treatment; Pediatric Nephrology (2017).
5. Juan D.Ordoñez et al.; The increased risk of coronary heart disease associated with nephrotic syndrome; Kidney International (1993).
6. S Afroz, A H Khan, and D K Roy; Thyroid function in children with nephrotic syndrome; Mymensingh Medical Journal (2011).
7. Nephrotic syndrome in children; NHS
8. Nutrition and Nephrotic Syndrome; Stanford Children’s Hospital