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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.

PubMed Health Glossary
(Source: 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:

  • proteinuria—large amounts of protein in the urine
  • hyperlipidemia—higher than normal fat and cholesterol levels in the blood
  • edema, or swelling, usually in the legs, feet, or ankles and less often in the hands or face
  • hypoalbuminia—low levels of albumin in the blood

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

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?

No strong evidence for any interventions for preventing infection in nephrotic syndrome

Patients with nephrotic syndrome, particularly children, are susceptible to infections. Infections can cause frequent relapses of illness, poor response to therapies (e.g. steroids) and severe infections occasionally lead to death. Oral antibiotics, pneumococcal vaccination, some immunomodulators and Chinese medicinal herbs have been used/recommended for reducing the risk of infection. No studies on antibiotics, pneumococcal vaccination and any other non‐drug prophylaxis were identified. This review found that intravenous immunoglobulin (IVIG), thymosin, oral transfer factor, Bacillus Calmette‐Guerin (BCG) vaccine injection and two kinds of Chinese medicinal herbs (Huangqi granules and TIAOJINING) may help prevent infections in nephrotic children. These studies were methodologically poor. Currently there is no strong evidence for recommending any interventions for preventing infections in nephrotic syndrome. More research is needed.

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Summaries for consumers

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?

No strong evidence for any interventions for preventing infection in nephrotic syndrome

Patients with nephrotic syndrome, particularly children, are susceptible to infections. Infections can cause frequent relapses of illness, poor response to therapies (e.g. steroids) and severe infections occasionally lead to death. Oral antibiotics, pneumococcal vaccination, some immunomodulators and Chinese medicinal herbs have been used/recommended for reducing the risk of infection. No studies on antibiotics, pneumococcal vaccination and any other non‐drug prophylaxis were identified. This review found that intravenous immunoglobulin (IVIG), thymosin, oral transfer factor, Bacillus Calmette‐Guerin (BCG) vaccine injection and two kinds of Chinese medicinal herbs (Huangqi granules and TIAOJINING) may help prevent infections in nephrotic children. These studies were methodologically poor. Currently there is no strong evidence for recommending any interventions for preventing infections in nephrotic syndrome. More research is needed.

See all (11)

Terms to know

Edema
Swelling caused by excess fluid in body tissues.
High Blood Cholesterol (Hypercholesterolemia)
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, High Blood Cholesterol (Hypercholesterolemia), Hyperlipidemia

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