Managing Nephrotic syndrome

A friend recently called to ask for medical advice concerning his six-year-old son on a Sunday morning. Apparently, he had done some self-medication without any improvement in the son’s condition before consulting me. He noted that he wanted to use the opportunity that his church was closer to my house to reach me.

The following conversation took place at the hospital.

Doctor: How may I help your son?

Friend: He has this recurrent swelling on the face in the mornings, which goes down in the evenings. I have called another doctor who said it might be a feature of allergy. What could he be reacting to?

Doctor: Okay, you will need to register in the hospital and obtain a card for your son to have a proper treatment.

Friend: Okay.

After the history and clinical examination, a quick analysis of the urine was conducted which showed evidence of protein 3+. There was also a provisional diagnosis and my friend was advised to do further tests for the son.

After the tests, I disclosed the results to my friend.He accepted and said he had no reason to doubt my judgment.

All results were suggestive of kidney disorder called Nephrotic Syndrome. He was treated and was okay. A self-explanatory book from the Canadian Kidney Foundation was then given to him to read to enable him to know more about Nephrotic syndrome.

Nephrotic Syndrome in children

Nephrotic syndrome is a condition in which the kidneys “leak” protein from the blood into the urine. In children, Nephrotic syndrome may only be temporary, or it may be an early sign of kidney damage.

Nephrotic syndrome, also called nephrosis, is defined by the presence of proteinuria, oedema, hyperlipidemia, and hypoalbuminemia.

The most common type of Nephrotic syndrome in children is called minimal change disease. With minimal change disease, there are very tiny physical changes in the tiny filters (called glomeruli) in the kidneys.

Most children will grow out of minimal change disease in their teen years. Other types of Nephrotic syndrome can be harder to treat and may cause more serious, long-term problems.

Causes

Primary childhood Nephrotic syndrome: Researchers have linked certain diseases and some specific genetic changes that damage the kidneys with primary childhood Nephrotic syndrome. The cause of secondary childhood Nephrotic syndrome is an underlying disease or infection. Congenital diseases – diseases that are present at birth – can also cause childhood Nephrotic syndrome.

Symptoms

Oedema (swelling) is the symptom in about 95 per cent of children with Nephrotic syndrome. It is typically found in the lower extremities, face and periorbital regions, scrotum or labia, and abdomen (ascites), ankles or feet.

Test

In order to establish the presence of Nephrotic syndrome, laboratory tests should confirm the existence of marked proteinuria, hypoalbuminemia, and hyperlipidemia. Therefore, initial laboratory testing should include the following: Urinalysis, Urine protein quantification, Serum albumin, lipid profile. In some cases, your child’s doctor may suggest a kidney biopsy. This means that a tiny piece of your child’s kidney will be removed and viewed under a microscope.

Treatment

Soon after Nephrotic syndrome is diagnosed, the patient and family are educated about the disease, its management, and its expected course. The family will participate in therapeutic decisions and are encouraged to adhere to the medical regimen. A steroids, diuretic (water pill), low-sodium (low salt) diets, in extreme cases, albumin (a kind of protein), given through the vein, can help to replace some of the protein in the blood.

Is your child experiencing an unusual weight gain from swollen face, swollen tummy, swollen body, swollen scrotum or swollen legs? It could be Nephrotic syndrome. Talk to your child Physician immediately.

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PUNCH.