Understanding Nephrotic Syndrome: Causes, Symptoms and Treatment

Dr. Nayana Vijay, Consultant Nephrologist, SUT Hospital, Pattom

The kidneys play a vital role in maintaining the body’s internal balance by acting as filtration units. They carefully regulate the levels of proteins and essential ions like sodium and potassium, ensuring the body functions optimally. One of the key indicators of kidney health is the amount of protein excreted in the urine. Normally, this should be less than 150 mg per day. However, in nephrotic syndrome, this can rise dramatically—exceeding 3.5 grams (3500 mg) per day.

What is Nephrotic Syndrome?

Nephrotic syndrome is a kidney disorder characterized by the excessive loss of protein in the urine due to impaired filtration. It is broadly classified into two types:

1. Primary Nephrotic Syndrome
This occurs when the filtration function of the kidneys is directly impaired due to kidney damage. This leads to leakage of protein into the urine.
2. Secondary Nephrotic Syndrome
In this type, the protein loss is due to other underlying conditions such as:
- Infections (e.g., malaria, typhoid, hepatitis)
- Medications (e.g., analgesics, chemotherapy drugs, certain home remedies)
- Connective tissue disorders
- Cancers (often detected during investigation for unexplained protein loss)

Why Early Treatment Matters?

If left untreated, nephrotic syndrome can progress into chronic glomerulonephritis, a condition that causes permanent kidney damage. The continuous loss of proteins, especially those involved in immune responses and blood clotting, can result in serious complications such as:

- Blood clots affecting the brain, heart, kidneys, and limbs
- Heart disease
- Hypertension
- Increased vulnerability to infections due to weakened immunity

Symptoms

- Foamy urine (a sign of excess protein)- Swelling (edema) around the eyes, limbs, or even the whole body in severe cases

How is it Diagnosed?

- Urine protein tests, including spot urine protein-creatinine ratio or 24-hour urine collection- Blood tests to identify the underlying cause- Kidney biopsy in certain cases, to determine the severity and specific cause of kidney damage

Treatment Approaches

Managing nephrotic syndrome requires a multifaceted treatment plan:- Anti-inflammatory medications to control kidney inflammation- Drugs that reduce protein loss (anti-proteinuric agents)- Specific treatments targeting the underlying condition causing the syndrome

By the time many patients see a nephrologist, they may have already taken medications in incorrect combinations, potentially worsening their condition. It is crucial to consult a specialist who can:
- Diagnose the condition accurately
- Follow established treatment guidelines
- Minimize complications
- Guide the patient back to a normal, healthy life