Nephrotic Syndrome in Children

Nephrotic syndrome is when the kidney malfunctions and leaks too much albumin into the urine. Albumin is a type of protein, and a high concentration of this protein in the urine indicates either one or both kidneys are not functioning properly.

The kidney consists of many glomerulus – a network or coil of tiny blood vessels. The main function of these glomeruli is to filter the blood and pass out all the waste materials. When these glomeruli stop functioning properly, it leads to nephrotic syndrome.

The child may have the following symptoms if suffering from this illness –

• Excess albumin in the urine
• Very little protein in the blood
• Water retention in the body – especially around the belly
• Edema – tissue swelling due to the water retention
• Passes very little urine as the body retains all the fluid
• Unexplainable weight gain
• Blood cholesterol levels are very high

Types of Nephrotic Syndrome in Children

We can classify it in different ways – the way they occur and how they develop.

Types Based on Occurrence-

Idiopathic – The cause is unknown. Most children with nephrotic syndrome suffer from the idiopathic kind.

Secondary – When other health conditions impact the kidneys and lead to nephrotic syndrome.

Congenital – When the syndrome is present from birth. This is a very rare condition caused by genetic abnormality. This type can be aggressive, requiring the child to undergo a kidney transplant within the first few years of their lives.

Types Based on Impact

MCD – Minimal Change Disease is when the tissues and the kidneys both look normal and may have very minimal changes when inspected under a microscope.

FSGS – Focal Sclerosis is a more aggressive type of this disease that may not respond well to steroids. The child might need multiple biopsies and continuous medication to keep the condition under control.

Causes of Nephrotic Syndrome in Children

In most cases of nephrotic syndrome in children, it is idiopathic, meaning the cause is unknown. In rare cases, certain viral infections can affect the kidneys, leading to this disorder in children.
A child is at a higher risk of nephrotic syndrome if-

• They are suffering from other health issues or infections that affect the kidneys
• They are on medications that can hurt the kidneys

Symptoms of Nephrotic Syndrome in Children

If your child is suffering from nephrotic syndrome, you may notice one or more of the following symptoms. Remember, different types of nephrotic syndromes can have different effects on the child. The signs and symptoms can also vary from child to child. Some of the symptoms are-

• Fatigue or feeling very tired easily
• A loss or decrease in appetite
• Swelling in parts of the body and weight gain
• Swelling or pain around the stomach
• Urine is foamy
• Edema
• Hair looks dull and lifeless due to a lack of protein in the blood
• Fingernail beds look pale
• Develops allergies or intolerances to food items

Diagnosis of Childhood Nephrotic Syndrome

When you notice any of the symptoms and consult your pediatrician, they will do the following to confirm a diagnosis of this illness-

Medical History –

To understand if it could be congenital or if there are other health issues that could be impacting the kidneys.

Tests –

A urine test will check the protein levels in the urine. Next will be a blood test to check for protein levels and cholesterol in the blood.

Renal Ultrasound –

To check the size and shape of the kidney, check for masses or cysts in the kidney, and also check for other problems.

Renal Biopsy –

If the kidney tissue does not look normal, the doctor will ask for a sample. The technician will analyze the sample under a microscope to understand the health of the kidneys.

Risks and Complications of Nephrotic Syndrome

In most cases, the child will get better and grow out of this illness as they reach adulthood. However, in rare cases, it can lead to the following complications-

Blood Clots –

If the kidneys are unable to filter the blood properly, it can lead to a loss of important proteins responsible for preventing blood clots. As a result, more clots can develop.

Blood Pressure –

Accumulation of fluids in the body can increase blood pressure.

Blood Cholesterol –

A lack of albumin in the blood will trigger the liver to produce more albumin along with cholesterol and triglycerides. Thus increasing their levels in the blood.

Infections –

When kidneys don’t function properly, it increases the risk of infections.

Damage to Kidneys –

When kidneys don’t filter the wastes effectively, the wastes will build up in the blood requiring external intervention such as dialysis.

Poor Nutrition –

When blood does not have sufficient protein, it can lead to low blood protein, anemia, low vitamin D levels, and malnutrition. It can even lead to weight loss but edema may make it difficult to identify this.

Treatment of Nephrotic Syndrome in Children

Different types of nephrotic syndrome have different treatments. In most cases, the child is put on prednisolone, a steroid medicine. The duration and dosage varies from case to case.

If it is due to the impact of some underlying health condition on the kidneys, doctors will address the issue first. They will prescribe medications and treatments to clear up the health issue and reassess the child’s kidneys after a few days.

If the nephrotic syndrome is FSGS (Focal Sclerosis), the doctor might try different medications. They will most likely stick to the medicine the child responds to. In most cases, the child will have to stay on these medications forever, as FSGS can relapse.

If it is MCD (Minimal Change Disease), the doctor will prescribe medications until the syndrome goes into remission. If there is a relapse, the doctor will reassess and prescribe medications accordingly.

Tips to Prevent Nephrotic Syndrome in Kids

You cannot always prevent nephrotic syndrome in children as most are idiopathic or congenital, meaning it could be genetic.

You can do the following to prevent damage to the glomeruli which in turn can lead to nephrotic syndrome-

• Ensure blood sugar and blood pressure are under control, especially in children suffering from diabetes
• Do not miss any of the child’s vaccinations
• When the doctor prescribes antibiotics for an illness, finish the full course to avoid relapses

Nephrotic syndrome in children is mostly idiopathic or genetic, which means, you cannot control it. However, you can ensure your child is healthy and reduce the risks of contracting this disease. If your child is suffering from nephrotic syndrome, be patient and understanding with the suffering child. In most cases, they will outgrow it when they reach their late teens or adulthood.

FAQ’s

1. Can You Cure Nephrotic Syndrome in Children?

Many children will outgrow nephrotic syndrome when they reach their teens. Children who suffer from an aggressive type of this syndrome may require lifelong medications and follow-up care.

2. Will Congenital Nephrotic Syndrome Affect All Children in The Family?

No, congenital nephrotic syndrome is very rare. In most cases, it affects only one child.