Nephrotic syndrome in children

Nephrotic syndrome is a kidney condition in which the kidneys leak large amounts of protein into the urine. The loss of protein causes swelling, especially around the eyes and legs, and raises the risk of infection and blood clots. It's more commonly diagnosed in children, but adults can also be affected.

Symptoms

• Swelling (oedema) — around the eyes in the morning, on the legs and abdomen as the day goes on
• Foamy urine (from the protein)
• Weight gain from fluid retention
• Tiredness
• Loss of appetite
• Increased susceptibility to infections

Causes

• In children — most cases are "minimal change disease," which usually responds well to steroids
• In adults — causes include membranous nephropathy, focal segmental glomerulosclerosis (FSGS), diabetic kidney disease, lupus, and others
• Sometimes nephrotic syndrome is linked to infections, medicines, or other underlying illness

Diagnosis

• Urine tests showing heavy protein loss
• Blood tests showing low albumin (a blood protein) and raised cholesterol
• Kidney ultrasound
• Kidney biopsy — usually done in adults or in children who don't respond to initial treatment, to identify the specific cause and guide therapy

Treatment

Depends on the cause:

• Steroids — first-line in children with minimal change disease; most respond well
• Other immune-suppressing medicines — for steroid-resistant or specific types
• Medicines to reduce protein loss and control blood pressure
• Water pills for severe swelling
• Low-salt diet
• Preventing infections (including timely vaccinations)
• Treating the underlying condition when one is identified

Most children with minimal change disease recover fully, though relapses are common. Adult nephrotic syndrome varies by cause — some forms respond very well, others need long-term management. Early referral to a nephrologist makes a real difference.