Are your kidneys excreting too much protein? Let's talk about Nephrotic Syndrome!

Have your legs, arms, or face suddenly started swelling? Or is your urine like a baby's body swelling? Does it look like foam when you urinate ? These could be a minor problem with your kidneys, which could be due to a medical condition. Today we are going to talk about one such kidney disease, 'Nephrotic Syndrome'. Don't worry, we will talk about this simply, in a way that you can understand.

What is Nephrotic Syndrome?

Simply put, nephrotic syndrome is a condition in which our kidneys excrete too much protein in the urine. Doctors call this ``proteinuria''. To be precise, if more than 3 grams of protein (a little heavier than a US penny) is excreted in the urine per day, that is the main symptom of this condition. This is about 20 times more than the amount excreted by healthy kidneys.

Now think of our kidneys as a filter . This filter has tiny blood vessels, which we call `(glomeruli)` . These `(glomeruli)` filter out waste products (for example, nitrogenous waste `(urea)`, muscle waste `(creatinine)`, and acids), as well as unnecessary water from the blood. Then they are excreted as urine. Normally, in a healthy kidney, the `(glomeruli)` filters out things that the body needs, such as proteins, and keeps them in the blood, especially the protein `(albumin)` . But when these `(glomeruli)` are damaged, they do not work properly. Then, valuable proteins like `(albumin)` easily accumulate in the urine.

Is this life threatening?

Yes, nephrotic syndrome is a serious condition . If not treated properly, it can lead to other complications and even affect your life. Therefore, it is very important to be aware of this and seek medical advice immediately if you have symptoms.

Who gets nephrotic syndrome?

Anyone can develop this. However, people who have diabetes-related kidney disease, those with certain allergies, and those with a family history of this type of kidney disease (with nephrotic syndrome) are more likely to develop it.

This is not a very common disease.

• It affects about 1 in 50,000 children each year. It is most often diagnosed in children between the ages of 2 and 5. Boys are twice as likely to develop it as girls.
• In adults , this occurs in about three out of every hundred thousand people per year.

How does nephrotic syndrome affect the body?

When proteins, which are very important to our bodies, are excreted in the urine, a variety of problems arise.

• Some proteins help stop blood from clotting . When they are missing, blood clots can form.
• Another important type of protein is`(Immunoglobulins)` . These help our immune system fight diseases and infections. When these are missing, we can easily get infections. For example:
• `(Pneumonia)` (Pneumonia)
• Cellulitis (a bacterial infection of the skin)
• Peritonitis (infection of the lining of the abdomen)

What are the symptoms of nephrotic syndrome?

It is important to pay close attention to these symptoms:

• Having a lot of protein `(albumin)` in the urine (`(albuminuria)`) : More than 3.5 grams of `(albumin)` protein is excreted per day.
• Increased levels of fat and cholesterol in the blood (hyperlipidemia) .
• Swelling (`(edema)`) : Most often, the legs, ankles, and feet swell. Sometimes the hands and face can also swell. Imagine, if your child wakes up in the morning and the area around their eyes looks swollen, that could also be a sign of this.
• Decreased levels of albumin protein in the blood (hypoalbuminemia) .
• Food is tasteless .
• Feeling tired all the time .
• Stomach pain (anywhere from the ribs to the lower abdomen).
• Foamy urine , like soapy water.

Another thing is that our body loses essential minerals and vitamins, especially calcium and vitamin D , in this way. In young children, this can affect growth. Hair loss, weak nails, and bone-weakening diseases such as ``(Osteoporosis)`` (bone thinning disease) can also occur.

What are the most common complications of nephrotic syndrome?

If left untreated, complications such as:

• `(Acute kidney injury)` - A condition in which the kidneys suddenly stop working properly.
• Anemia - A lack of healthy blood cells that carry oxygen to the body's organs.
• Coronary artery disease - Fatty deposits in the arteries that supply blood to the heart.
• Hypertension - Blood pressure that is higher than normal as it travels through the blood vessels.
• Hypothyroidism - The thyroid gland does not release enough thyroid hormone into the blood.

What are the causes of nephrotic syndrome?

Most often, these `(glomeruli)` are damaged due to kidney diseases. Doctors and researchers are still not sure why these diseases directly affect the `(glomeruli)`. These damaged `(glomeruli)` are the main cause of nephrotic syndrome. Some of these diseases are:

• `(Amyloidosis)` : In this, a type of protein called amyloid is deposited in our vital organs. This often happens in the kidneys. Then the filtering ability of the kidneys decreases.
• `(Diabetes-related nephropathy)`Nephropathy: This is when the kidneys do not work properly. This condition occurs when diabetes damages one or more of the nerves in the kidneys. This can cause numbness, muscle weakness, and pain.
• Focal segmental glomerulosclerosis (FSGS) : This causes scarring in small segments of the glomeruli. This can lead to swelling, kidney failure, and protein in the urine.
• Lupus : Lupus is an autoimmune disease. It causes inflammation, swelling, and pain throughout the body. It can also affect the kidneys.
• Membranous nephropathy : In this, our body's own immune system attacks the filtering membranes in the kidneys.
• Minimal change disease (MCD) : This is also a type of nephropathy in which the kidneys do not function properly. However, a kidney biopsy does not show any significant damage to the glomeruli or kidney tissue. Although it can occur at any age, it is most common in young children.

How is nephrotic syndrome diagnosed?

Doctors perform several tests to diagnose this disease:

Urinalysis tests

This is detected by a urinalysis, which looks at the appearance, chemical composition, and microscopic appearance of your urine.

• Dipstick test : In this test, you urinate into a special container at a doctor's office or hospital. Then a doctor or nurse places a chemical-coated paper strip (dipstick) into the container. If there is albumin in your urine, the strip will change color.
• Urine protein tests : These tests are done if a more accurate measurement is needed.
• A single urine sample : This is sent to a lab. They will look at how much `(albumin)` and `(creatinine)` are in your urine (`(albumin-to-creatinine ratio)`). If you have more than 30 milligrams of `(albumin)` per gram of `(creatinine)`, that could be a problem.
• 24-hour urine collection : The doctor will give you a bottle to collect your urine at home. On the day of the test:
• First thing in the morning, when you wake up, urinate into the toilet as usual.
• Then urinate into that bottle all day long until you go to bed at night.
• The next morning, as soon as you wake up, urinate into the same bottle for the last time.
• Then you have to take that sample to the doctor's office or to the lab, where they only measure the amount of `(albumin)`.

Blood tests

In this, the doctor uses a thin needle to take a small amount of blood from a vein in your arm. It is sent to a lab for testing. If there is a low level of `(albumin)` or other proteins in the blood, it may be nephrotic syndrome. They also check the levels of cholesterol and `(triglyceride)` in the blood. When `(albumin)` is low, these can increase.

Kidney biopsy

In this procedure, the doctor takes a small piece of tissue from your kidney and examines it under a microscope. The area is numbed before the procedure, so you won't feel any pain. You may also be given a small amount of sleeping medicine to help you relax. The doctor then inserts a needle through your skin into your kidney to take the tissue sample.

However, if you have diabetes and your doctor suspects nephrotic syndrome, a kidney biopsy is often not necessary. Your medical history, urine tests, and blood tests can help diagnose nephrotic syndrome caused by diabetes.

Can nephrotic syndrome be cured?

This is not a completely curable disease . But there is good news! If it occurs in young children, it often goes away by the time they are young, around 18-20 years old.

Treatment can control symptoms and stop further damage to the kidneys.

Treatment involves treating the underlying cause, reducing high blood pressure, cholesterol, swelling, and the risk of infection. Most often, it involves medication and dietary changes .

• Some high blood pressure medications can help control the kidney disease that causes nephrotic syndrome. For example:
• `(Angiotensin-converting enzyme (ACE) inhibitors)`
• `(Angiotensin receptor blockers (ARBs))`
• These medications reduce the pressure inside the glomeruli and reduce the amount of albumin excreted in the urine. Many people may need two or three medications to control their blood pressure.
• Along with an ACE inhibitor or an ARB, your doctor may prescribe a diuretic . Diuretics help your kidneys remove excess fluid from your blood. They can also help reduce blood pressure and swelling. Other medications that lower blood pressure include beta-blockers and calcium channel blockers .
• The doctor may prescribe ``statin`` medications to lower cholesterol.
• If you have nephrotic syndrome, it is also a good idea to get the influenza (flu) vaccine and the pneumococcal vaccine every year. The pneumococcal vaccine can protect against infections caused by bacteria called pneumococcus (e.g. ear infections, pneumonia, meningitis).
• Sometimes your doctor may prescribe blood thinners (anticoagulants), but these are only given if you develop a blood clot. They do not prevent nephrotic syndrome or its symptoms.

Do you need to be careful about food and drink?

Diet and drink do not have a significant effect on the development or prevention of nephrotic syndrome in adults. But if you have this condition,Some symptoms can be reduced by making dietary changes.

• Reducing salt (sodium) in your diet can help reduce swelling . Most of the sodium in the food we eat comes from salt. Drinking more water can also help reduce swelling.
• Reducing saturated fat and cholesterol in your diet can help control ``hyperlipidemia'' (high blood fat). It is best to limit foods such as full-fat dairy products, red meat, processed meat, cheese, fried foods, baked goods, and sweets.

How do I take care of myself?

The best way to manage your symptoms is to take your medications as prescribed by your doctor . It's also a good idea to eat a diet that's high in potassium and protein, but low in sodium, saturated fat, and cholesterol.

How quickly will I feel better after treatment?

This varies depending on the cause of nephrotic syndrome. Some people may start feeling better within a few days of starting treatment. For others, it may take weeks or even months. It's important to be patient.

What happens to someone with nephrotic syndrome?

If diagnosed and treated correctly, people with nephrotic syndrome have good outcomes . Most people respond well to treatment and go into remission (`(remission)`). This means that the symptoms go away. If you had nephrotic syndrome as a child, as mentioned earlier, it is possible that it will go away completely by the time you reach adulthood.

Can nephrotic syndrome be prevented?

Nephrotic syndrome cannot be prevented , but proper treatment of the underlying conditions that cause it (e.g., diabetes, high blood pressure) and dietary changes can help improve symptoms and reduce damage to the kidneys.

When should you see a doctor?

If you have symptoms of kidney disease, especially foamy urine and swelling, that last for more than a few days, see a doctor right away . The earlier it is detected, the easier it is to treat.

What questions should you ask the doctor?

You can ask these questions when you see the doctor:

• "How do you know I have nephrotic syndrome?"
• "Do I need to do any more tests to confirm your diagnosis?"
• "If I don't have nephrotic syndrome, what other condition could I have?"
• "What condition caused me to develop nephrotic syndrome?"
• "Do you think my nephrotic syndrome will go into remission with treatment?"
• "Will my child's nephrotic syndrome go away as he grows up?"
• "What medications or treatments do you recommend?"
• "Do I need to make any changes to my diet?"

Difference between Nephrotic Syndrome and Nephritic Syndrome

Both of these are conditions that affect the kidneys.

• The main symptom of nephrotic syndrome is a lot of protein in the urine.
• The main symptom of nephritic syndrome is inflammation of the kidneys. This inflammation can often be caused by infection, blood vessel disease, or degeneration.

Difference between Nephrotic Syndrome and Glomerulonephritis

Glomerulonephritis is also a kidney disease. Its symptoms are similar to nephrotic syndrome. However, the main difference is in the amount of protein excreted .

• If you have nephrotic syndrome, you excrete more than 3.5 grams of protein per day.
• If you have Glomerulonephritis, less than 3.5 grams of protein is excreted per day.

What is congenital nephrotic syndrome?

This is a condition that is present at birth . It can lead to permanent kidney failure, usually between the ages of 2 and 8. This is a hereditary kidney disease. That means it is passed on from parents to children.

Finally, things for you to remember (Take-Home Message)

So, in short, nephrotic syndrome is a condition in which the kidneys excrete too much protein in the urine. If you have symptoms like abdominal pain, foamy urine, swelling, loss of appetite, and frequent fatigue that last more than a few days, it is best to seek medical advice. Remember, early detection and treatment can help keep your kidneys healthy and prevent serious complications . Don't panic, just follow your doctor's instructions. I wish you a speedy recovery!

` Nephrotic Syndrome, Kidney Disease, Protein, Swelling, Urine Test, Pediatrics, Nephrotic Syndrome