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Nephrotic Syndrome in Adults
What is nephrotic syndrome?
Nephrotic syndrome is a condition marked by
- very high levels of protein in the urine, a condition called proteinuria
- low levels of protein in the blood
- swelling, especially around the eyes, feet, and hands
- high cholesterol
What causes nephrotic syndrome?
Nephrotic syndrome results from damage to the kidneys' glomeruli-tiny blood
vessels that filter wastes and excess water from the blood and send them to the
bladder as urine.
When the glomeruli are working properly, they keep protein in the blood from
leaking into the urine. Healthy kidneys allow less than 1 gram of protein to escape
through the urine in a day. In nephrotic syndrome, the damaged glomeruli allow 3
grams or more of protein to leak into the urine during a 24-hour period.
As a result of this protein loss, the blood is deficient. Normal amounts
of blood protein are needed to help regulate fluid throughout the body. Protein
acts like a sponge to soak up fluid into the bloodstream. When blood is low in
protein, fluid accumulates in the body's tissues rather than circulating. The
fluid causes swelling and puffiness.
Nephrotic syndrome can occur with many diseases. In adults, the most common
causes are diabetic nephropathy and membranous nephropathy. In older adults, the
most common cause is amyloidosis. Prevention of nephrotic syndrome relies on
controlling these diseases. Frequently, however, the cause of nephrotic syndrome
is unknown.
How is nephrotic syndrome diagnosed?
Your doctor will need blood and urine samples to evaluate your condition.
A high level of protein in a spot urine sample may indicate nephrotic syndrome.
The doctor may order a 24-hour collection of urine in order to get a more precise
measurement.
Blood tests may show low levels of protein. If kidney damage is advanced,
waste products such as creatinine and urea nitrogen may build up in the blood.
Once nephrotic syndrome is established, the doctor may recommend a kidney biopsy-a
procedure in which tiny pieces of the kidney are removed for examination
with a microscope. The biopsy may reveal the underlying disease so that
the doctor can determine a course of treatment. If a person has had diabetes
for some time, and the patient history and laboratory tests are consistent with
diabetic nephropathy, a biopsy is rarely necessary.
How is nephrotic syndrome treated?
In addition to addressing the underlying cause, treatment of nephrotic syndrome
focuses on reducing high cholesterol, blood pressure, and protein in urine through
diet, medications, or both. Two groups of blood pressure
medications-angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor
blockers (ARBs)-also protect the kidneys by reducing proteinuria.
Some people may benefit from limiting protein in their diet to reduce the
buildup of wastes in the blood.
Nephrotic syndrome may go away once the underlying cause, if known, has been
treated. In children, 80 percent of cases of nephrotic syndrome are caused by
a condition called minimal change disease, which can be successfully treated
with prednisone. However, in adults, most of the time the underlying cause is
a kidney disease such as membranous nephropathy or focal segmental
glomerulonephritis, diseases that are treated with corticosteroids,
immunosuppressive drugs, and, in some cases, cytotoxic agents. Unfortunately,
these treatments do not always bring about remission of nephrotic syndrome.
Depending on the disease, as many as half of the patients may develop chronic
kidney disease that progresses to end-stage renal disease. In these cases, the
kidneys gradually lose their ability to filter wastes and excess water from the
blood. If kidney failure occurs, the person will need dialysis or a kidney
transplant.
For More Information:
American Kidney Fund
National Heart, Lung, and Blood Institute
Health Information Center
National Kidney Foundation, Inc.
Source: NIH Publication No. 07-4624, February 2007
Reprinted by Editorial Staff, August 2007
Last update, August 2008
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