Nephrotic syndrome is passage of too much protein in urine. It is a kidney disorder and very common among children. Your kidneys filter waste and excess water in your blood. But in nephrotic syndrome small blood vessels in kidney are damaged. So kidneys cannot do filter function properly. Even though it is common among children, it also can be seen among adults. In this article you can find some important advices as parents about nephrotic syndrome in children.
- Swelling of the face (around eyes) and legs (ankles). Initially swelling occurs in face and later extends to legs. Swelling in more common towards the evening.
- Foamy urine – this is due to excessive protein in urine
- Weight gain – due to water retention in body
Primary reason for nephrotic syndrome is damage to the glomeruli. Glomeruli are microscopic units in your kidneys which is responsible for filter function. Any disease which can damage these glomeruli can cause nephrotic syndrome. Here are some causes for nephrotic syndrome;
- Minimal change disease – this is the commonest cause of nephrotic syndrome in children. There is loss of function of the kidneys. But if kidney tissues are examined using a microscope it may be normal. Therefore it is called minimal change disease.
- Focal segmental glomerulosclerosis – There is scarring of some glomeruli. And there is visible microscopic lesions.
- Membranous nephropathy – common in adults. There are some immune complexes within the glomeruli. They causes thickening of glomeruli.
- Diabetic nephropathy – diabetes is a cause for nephrotic syndrome.
- Systemic Lupus Erythematosus (SLE)
High blood pressure or hypertension is a common complication in nephrotic syndrome. It is mainly due to volume loss in body. There are several effective drugs for hypertension.
Children with nephrotic syndrome are prone to get infections. Because their immune function is low. However it can be prevented by giving appropriate vaccines. Eg: pneumococcal and varicella vaccine
High blood cholesterol
Albumin level in your blood is low due to passage of albumin via urine. Then your liver makes more albumin. At the same time liver releases more cholesterol and triglycerides.
Albumin is a protein. So there is low protein in blood. This causes poor nutrition. This mainly affects children.
Acute and Chronic kidney disease
Nephrotic syndrome is a kidney disease. Kidneys loss their function over time. This causes acute and chronic kidney disease.
There are some proteins which prevent blood clot formation. But in nephrotic syndrome those proteins also get loss. So blood clots may be formed anywhere of body.
Important advice for parents – Nephrotic syndrome in children
Nephrotic syndrome in children has a long term effect. Most of the time it relapse again. Therefore in management of nephrotic syndrome in children, parents also have a key role. You should have an idea about disease, causes and it’s complications. Now you have read them. Here are some other important aspects you should know:
Doing urine protein test at home
Foamy urine is the best symptom of nephrotic syndrome. So nephrotic syndrome can be screened by looking at urine. If your child has nephrotic syndrome you can do this at home.
There are several ways of doing this. One method is dipstick test. There are strips which gives a colour change to urine. You have to buy these strips from a pharmacy. Then dip the marked end of the strip in urine for 3 seconds and compare the colour change with the code given in the pack.
Other method is heat test. You can do it at home without any strips. You need only a test tube and few amount of acetic acid.
Fill about two third of test tube with urine. Then heat the tube until reach boiling point. If there is turbidity, add two drops of 10% acetic acid. Because phosphate in the urine also appears as turbid. But it may disappear after adding acetic acid.
Read the degree of turbidity by holding the test tube against a black print. You can use a newspaper for that.
So how to grade protein in urine. It’s below:
- No protein – No turbidity
- Trace protein – slight turbidity with no difficulty in reading the print
- + – clouding of the print but possible to read the print
- ++ – can’t read the print but can notice black
- +++ – can’t notice black
- ++++ = can’t notice black and there is a precipitate
If your child is ill you have to do this everyday. Doctors recommend to admit child to the hospital if the reading is ++ or more for at least 3 consecutive days.
Diet of the child
Diet is very important. Because child may have poor nutrition. You should give a balanced diet to child. Adequate proteins, carbohydrates and fat. Also add some fruits. Always ensure physical activity of child.
Here are some food you can add to the plate:
- lean meats (poultry, fish, shellfish)
- dried beans
- peanut butter
- fresh or frozen fruit (apples, watermelons, pears, oranges, bananas)
- fresh or frozen vegetables (green beans, lettuce, tomatoes)
- low-sodium canned vegetables
- whole grains
- unsalted snacks (potato chips, nuts, popcorn)
- cottage cheese
- butter or margarine
Protect your child
Your child is having a risk of having infections. So it’s your duty to protect your child. Don’t allow the child to go high crowded places. Always teach him/her protective measures such as hand washing. Seek early treatments for infections.
If your child is on prednisolone or other steroids some vaccines are contraindicated. There are vaccines called ‘live vaccines’ which should be avoided until steroids have been discontinued for at least 3 months.
Good mental health
Most of the time both child and parent (usually mother) have to stay at hospital for a longer duration. It may affect their mental health also. So it’s better to have some precautions to prevent these.
Maintain a diary
Try to maintain a diary which shows records of home protein tests, daily medications and information about infections your child had. It may be easy for your doctor.