Nephrotic syndrome is
a sign that your
kidneys are not working right. You have nephrotic
syndrome if you have high levels of protein in your urine, low levels of
protein in the blood, and high cholesterol.
Nephrotic syndrome is
not a disease. It is a warning that something is damaging your kidneys. Without
treatment, that problem could cause kidney failure. So it's important to get
treatment right away.
Nephrotic syndrome can occur at any age. But
it is most common in children between the ages of 18 months and 8 years.
There are tiny
blood vessels in the
kidneys that filter waste and extra water from the
blood. When these filters are damaged, you get nephrotic syndrome. Protein
helps move water from the tissues into the blood. Healthy kidneys keep the
right amount of protein in the blood. Damaged kidneys let protein slip from the
blood into the urine. Without enough protein in the blood, fluid builds up in
the tissues. This can cause swelling.
Many things can cause this
blood vessel damage, including
lupus, infection, certain cancers, and some medicines.
Sometimes doctors don't know what causes it.
A type of kidney
disease called minimal change disease (also called nil disease) causes most of
the cases of nephrotic syndrome in children. Doctors don't know what causes
minimal change disease.
The most common early
symptom of nephrotic syndrome, in both children and adults, is swelling in the
tissues around the eyes or in the feet or ankles. They may also have swelling
in the lungs that can make it hard to breathe.
But many people who
have nephrotic syndrome don't have symptoms.
diagnose nephrotic syndrome using blood and urine tests.
have other tests to see what is causing nephrotic syndrome. You may also
have a kidney
biopsy, in which the doctor takes a sample of tissue for testing.
Treatment focuses on reversing,
slowing, or preventing further kidney damage. The treatment you need depends on
whether you are an adult or a child and what health problem caused nephrotic
syndrome. You may take medicine. And your doctor may suggest a diet that is low
in salt and protein.
With treatment, young children usually get
better and have no lasting problems. Often treatment is not as successful in
older children and adults. If the kidney damage is not stopped, it can lead to
chronic kidney disease.
Learning about nephrotic syndrome:
Living with nephrotic syndrome:
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Nephrotic syndrome is caused by damage
to the tiny blood vessels in the
kidney that filter waste and excess water from the
Many conditions and diseases can cause nephrotic syndrome,
Many people who have
nephrotic syndrome do not have any noticeable physical
symptoms. When symptoms are present, they can include:
Signs of nephrotic syndrome in blood and urine tests can
Nephrotic syndrome occurs when the kidneys are not working properly. Healthy
kidneys filter out excess water, salts, and other things from the blood in our
body. Large amounts of protein and minerals are lost through urine when kidneys
have damaged filters. The body is left without enough protein to soak up water.
As a result, the water moves from the blood supply into body tissues. This
causes swelling in the tissues where the water pools.
common areas of swelling are in the face around the eyes and in the ankles and
feet. Fluid can also collect in the lungs, making it difficult to breathe.
Complications of nephrotic syndrome can include:
Acute nephrotic syndrome can develop quickly over a few
days to a few weeks, causing edema (swelling) and possibly kidney failure.
If another severe medical condition (such as
high blood pressure) is causing nephrotic syndrome,
you may have complications from the other condition also.
Most children who have nephrotic syndrome do well with treatment and have
a normal life expectancy.
Complete recovery is
possible. Doctors define complete recovery as living without symptoms or
treatment for more than 2 years.
Diabetes is the most common cause of
nephrotic syndrome in adults.
You also have an increased risk of developing nephrotic
syndrome if you have a disease that results in an
impaired immune system, such as
Nephrotic syndrome is a relatively
rare disease that can occur at any age.
Call 911 or other emergency services if you have
nephrotic syndrome and you develop:
Call your doctor immediately if you
If you think your child or you may have
nephrotic syndrome, or if your child or you have the condition and the symptoms
are getting worse, don't wait to get treatment. Call your doctor right away.
Health professionals who can diagnose nephrotic syndrome
Nephrotic syndrome is usually treated by a nephrologist
or a pediatric nephrologist, depending on the age of the person
To prepare for your appointment, see the topic Making the Most of Your Appointment.
In addition to a
medical history and physical exam, other tests to
nephrotic syndrome include:
You may need other tests before treatment for nephrotic
syndrome begins. These include:
In adults, testing usually includes:
Unless nephrotic syndrome is clearly caused by diabetes, a
kidney biopsy is usually done to find the cause.
Children do not usually have a biopsy.
nephrotic syndrome depends on the cause and the age of
the person who has the condition. Medicines, changes in diet, and care for
other conditions, such as
diabetes or high blood pressure, are all possible
treatments for this syndrome. These treatments may reverse, slow, or prevent
further kidney damage.
Most children who have nephrotic syndrome
do well with treatment and have a normal life expectancy.
Doctors define complete recovery as living without symptoms or
treatment for more than 2 years.
nephrotic syndrome depends on the cause of the disease
and may include:
First treatments can
last from 6 to 15 weeks, often longer in adults. Depending on how severe your
symptoms are or whether they return, ongoing treatment may be needed for
months to years, or even for the rest of your life.
Ongoing treatment for
nephrotic syndrome and complications of the disease
You may need emotional support during treatment for
nephrotic syndrome. If you or your child has nephrotic syndrome and you are
having a hard time handling treatment or the severity of your child's
condition, it may help to talk with a doctor or seek
nephrotic syndrome is unsuccessful. If this occurs,
you may develop
chronic kidney disease. Your doctor may recommend that
peritoneal dialysis, or consider a
kidney transplant. For more information, see the topic
Chronic Kidney Disease.
Clinical trials are ongoing to test more effective
medicines for the treatment of steroid-resistant (relapsing) nephrotic
syndrome. If treatment has not successfully controlled your nephrotic syndrome,
ask your doctor about clinical trials. To take part in a clinical trial, you
may need to travel to a large treatment center.
Avoiding situations or controlling the
other diseases that can contribute to kidney disease can sometimes prevent
nephrotic syndrome. The earlier a person changes
the things that damage the kidneys, the better. You can help prevent kidney damage
If you were diagnosed with nephrotic syndrome in the
People who have
nephrotic syndrome need to see a doctor regularly to have their
kidney function checked. Children usually need to see a doctor more
often than adults do.
Take all of your medicines, even after you
begin to feel better. If you have side effects, contact your doctor before
stopping a medicine.
If you are taking medicines for another
health problem, you may need blood testing to see if you are getting the
correct amount of medicine. Make sure your doctor knows about all the
prescription and nonprescription medicines that you are taking.
You may help reduce symptoms of nephrotic syndrome and prevent other
health problems by:
Nephrotic syndrome is usually successfully treated with a combination of
Medicines to treat nephrotic syndrome include:
Most children are successfully treated with
corticosteroids, though relapses are common.1
Clinical trials are ongoing to test
more effective medicines for the treatment of steroid-resistant (relapsing)
nephrotic syndrome. If treatment has not successfully controlled your nephrotic
syndrome, ask your doctor about information on clinical trials. To take part in
a clinical trial, you may need to travel to a large treatment center.
Most children who have nephrotic
syndrome do well with treatment and have a normal life expectancy.
Surgery is not used to treat
nephrotic syndrome. But if treatment is not
controlling your condition and you have developed chronic kidney disease, your
doctor may recommend a
There are no other treatments
The American Kidney Fund is a national voluntary health
organization dedicated to improving the daily lives of people who have chronic
kidney disease. Its goal as a patient aid program is to relieve the financial
burden associated with chronic kidney failure. Also, the organization's
information service provides information about how to prevent and treat kidney
disease and about the great need for organ donors.
The National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC) provides information about diseases of the
kidneys and urologic system to people with these problems and to
their families, to health professionals, and to the public. NKUDIC answers
inquiries; develops, reviews, and distributes publications; and works closely
with professional and patient groups and government agencies to
coordinate resources about kidney and urologic diseases.
NKUDIC, a federal agency, is a service of the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part
of the National Institutes of Health under the U.S. Department of Health and
The National Kidney Foundation works to prevent kidney
and urinary tract diseases and help people affected by these conditions. Its
website has a lot of information about adult and child conditions. The site
has interactive tools, donor information, recipes for kidney disease patients,
and message boards for many kidney topics. Free materials, such as brochures
and newsletters, are available.
CitationsAmerican Academy of Pediatrics (2009). Management of childhood onset nephrotic syndrome. Pediatrics, 124(2): 747–757. Available online: http://www.pediatrics.org/cgi/content/full/124/2/747.Other Works ConsultedKodner C (2009). Nephrotic syndrome in adults: Diagnosis and management. American Family Physician, 80(10): 1129–1134.Lewis JB, Neilson EG (2008). Glomerular diseases. In
AS Fauci et al., eds., Harrison's Principles of Internal Medicine, 17th ed., vol. 2, pp. 1782–1797. New York:
McGraw-Hill.Nachman PH, et al. (2008). Primary glomerular disease.
In BM Brenner, SA Levine, eds., Brenner and Rector's The Kidney, 8th ed., vol. 1, pp. 987–1066. Philadelphia: Saunders Elsevier.
Praga M et al. (2011). Primary glomerular diseases In ET Bope et al., eds., Conn's Current Therapy 2011, pp. 714–719. Philadelphia: Saunders.
Vincenti FG, Amend WJC (2008). Nephrotic syndrome
section of Diagnosis of medical renal diseases. In EA Tanagho, JW McAninch,
eds., Smith's General Urology, 17th ed., pp. 524–526.
New York: McGraw-Hill.Watnik S, et al. (2010). Nephrotic syndrome section of Kidney disease. In SJ McPhee, MA Papadakis, eds., Current Medical Diagnosis and Treatment 2010, 49th ed., pp. 838–840. New York: McGraw-Hill.
May 7, 2012
Anne C. Poinier, MD - Internal Medicine & Tushar J. Vachharajani, MD, FASN, FACP - Nephrology
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