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Nephrotic Syndrome

A collection of symptoms that indicate kidney damage. Symptoms include high levels of protein in the urine, lack of protein in the blood, and high blood cholesterol. NIH - National Institute of Diabetes and Digestive and Kidney Diseases

About the Nephrotic Syndrome

Nephrotic syndrome is a collection of symptoms that indicate kidney damage. Nephrotic syndrome includes the following:

Albumin is a protein that acts like a sponge, drawing extra fluid from the body into the bloodstream where it remains until removed by the kidneys. When albumin leaks into the urine, the blood loses its capacity to absorb extra fluid from the body, causing edema.

Nephrotic syndrome results from a problem with the kidneys' filters, called glomeruli. Glomeruli are tiny blood vessels in the kidneys that remove wastes and excess fluids from the blood and send them to the bladder as urine.

As blood passes through healthy kidneys, the glomeruli filter out the waste products and allow the blood to retain cells and proteins the body needs. However, proteins from the blood, such as albumin, can leak into the urine when the glomeruli are damaged. In nephrotic syndrome, damaged glomeruli allow 3 grams or more of protein to leak into the urine when measured over a 24-hour period, which is more than 20 times the amount that healthy glomeruli allow...Read more about the Nephrotic Syndrome NIH - National Institute of Diabetes and Digestive and Kidney Diseases

What works? Research summarized

Evidence reviews

Astragalus in the prevention of upper respiratory tract infection in children with nephrotic syndrome: evidence-based clinical practice

Aims. To explore whether Astragalus or its formulations could prevent upper respiratory infection in children with nephrotic syndrome and how best to use it. Methods. We transformed a common clinical question in practice to an answerable question according to the PICO principle. Databases, including the Cochrane Library (Issue 5, 2012), PUBMED (1966-2012.8), CBM (1978-2012.8), VIP (1989-2012.8), and CNKI (1979-2012.8), were searched to identify Cochrane systematic reviews and clinical trials. Then, the quality of and recommendations from the clinical evidence were evaluated using the GRADEpro software. Results. The search yielded 537 papers. Only two studies with high validity were included for synthesis calculations. The results showed that Astragalus granules could effectively reduce URTI in children with nephrotic syndrome compared with prednisone treatment alone (23.9% versus 42.9%; RR = 0.56 and 95% CI = 0.33-0.93). The dose of Astragalus granules was 2.25 gram (equivalent to 15 gram crude Astragalus) twice per day, at least for 3-6 months. The level of evidence quality was low, but we still recommended the evidence to the patient according to GRADEpro with the opinion of the expert. Followup showed the incidence of URTI in this child decreased significantly. Conclusions. Astragalus granules may reduce the incidence of URTI in children with nephrotic syndrome.

Deflazacort in comparison to other steroids for nephrotic syndrome

Patients with nephrotic syndrome require steroids for long time and sometimes repeatedly resulting in various adverse effects. Deflazacort (DFZ) had been described as equally effective and with fewer side effects as compared with other steroids. This review evaluates the literature on efficacy and toxicity of DFZ as compared with other therapies for nephrotic syndrome. A systematic review of Pubmed database and Cochrane Central Register of Controlled Trials with last search date of 20(th) April 2011. Search terms included "nephrotic AND deflazacort" without any limitations. Randomized control trials comparing DFZ vs placebo or other therapies in subjects with nephrotic syndrome were included. Two authors extracted data independently. Three studies meet inclusion criteria and data were synthesized qualitatively. The limited evidence suggested that DFZ appeared to be equally effective in inducing remission or decreasing proteinuria in patients with nephrotic syndrome. It caused significantly less decrease in bone mineral content (BMC) in spine as compared with prednisolone. The results related to weight change, blood pressure change, Cushingoid symptoms, and urinary calcium excretion were inconsistent between included studies. By reviewing the available limited evidence, DFZ appears to be of similar efficacy for nephrotic patients, but there were inconsistent results regarding side effect profile of DFZ as compared with other steroids except for decrease in BMC where DFZ was better. There is need for larger randomized controlled trials to evaluate effectiveness and adverse effect profile of DFZ as compared with other steroids in nephrotic syndrome.

Corticosteroid drugs for several months after a child has nephrotic syndrome can reduce repeat episodes

Nephrotic syndrome is a condition where the kidneys leak protein from the blood into the urine. Most children who experience this syndrome have repeat episodes. When it is untreated, children can often die from infections. Corticosteroid drugs (prednisone, prednisolone) are used to treat nephrotic syndrome and so reduce the risk of these infections, but the drugs can also have serious side effects. This review identified 24 trials evaluating 1726 children. Continuing to take corticosteroid medications for several months after the first episode of nephrotic syndrome has an increasing ability to reduce the risk of relapses, without an increase in serious side effects.

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Summaries for consumers

Corticosteroid drugs for several months after a child has nephrotic syndrome can reduce repeat episodes

Nephrotic syndrome is a condition where the kidneys leak protein from the blood into the urine. Most children who experience this syndrome have repeat episodes. When it is untreated, children can often die from infections. Corticosteroid drugs (prednisone, prednisolone) are used to treat nephrotic syndrome and so reduce the risk of these infections, but the drugs can also have serious side effects. This review identified 24 trials evaluating 1726 children. Continuing to take corticosteroid medications for several months after the first episode of nephrotic syndrome has an increasing ability to reduce the risk of relapses, without an increase in serious side effects.

Cyclosporin may increase the number of children who achieve complete remission in steroid‐resistant nephrotic syndrome. Angiotensin converting enzyme (ACE) inhibitors significantly reduce the degree of proteinuria

Nephrotic syndrome is a condition where the kidneys leak protein from the blood into the urine. Corticosteroids are used in the first instance to achieve remission. Some children do not respond to this treatment and other agents such as cyclophosphamide, chlorambucil, cyclosporin or ACE inhibitors may be used. This review found that when cyclosporin was compared to placebo or no treatment there was a significant increase in the number of children who achieved complete remission. Cyclosporin also significantly increased the number of children, who achieved complete or partial remission compared with IV cyclophosphamide. There was no improvement with other immunosuppressive agents. However the number of studies was small. More research is needed.

Interventions for minimal change disease in adults with nephrotic syndrome

Nephrotic syndrome is a condition where the kidneys leak protein from the blood into the urine. Minimal change disease is the third most common primary kidney disease in adults with unexplained nephrotic syndrome (10% to 15%). Steroids have been used widely since the early 1970s for the treatment of adult‐onset minimal change disease, however the optimal agent, dose and duration has not been determined. This review identified three small studies (68 participants) comparing: 1) intravenous plus oral steroid treatment versus oral sterids; 2) oral versus short‐course intravenous steroid treatment; and 3) oral steroid treatment versus placebo. Only oral steroid treatment (compared to short‐course intravenous steroid treatment) showed an increase in the number of patients who achieved complete remission. However, the lack of available studies leaves important treatment questions unanswered; what is the optimal dose and duration of steroid treatment in new‐onset adult minimal change disease; how are relapses following steroid‐induced remission prevented and treated; and what are the appropriate treatments for steroid‐dependent or treatment‐resistant minimal change disease?

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Terms to know

Edema
Swelling caused by excess fluid in body tissues.
Hypercholesterolemia (High Blood Cholesterol)
Abnormally high levels of cholesterol in the blood.
Hyperlipidemia
Abnormally high levels of lipids (cholesterol, triglycerides) in the blood.
Hypoalbuminemia
Hypoalbuminemia is a medical condition where blood levels of albumin are abnormally low.
Proteins
A molecule made up of amino acids. Proteins are needed for the body to function properly. They are the basis of body structures, such as skin and hair, and of other substances such as enzymes, cytokines, and antibodies.
Proteinuria
A condition in which the urine contains large amounts of protein, a sign that the kidneys are not working properly.

More about Nephrotic Syndrome

Photo of an adult

Also called: NS

Other terms to know: See all 6
Edema, Hypercholesterolemia (High Blood Cholesterol), Hyperlipidemia

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