The main job of the kidneys, is to clean the blood, removing waste material that is produced by the body and any water that is not needed. They turn these things into urine. Most people have two kidneys and they are found in the small of the back, level with the bottom rib, on either side. From the kidneys, the urine then moves down a tube called the ureter into the bladder. The urine is then passed out of the body by contractions of the bladder through a single tube called the urethra when you go to the toilet.
Nephrotic Syndrome is caused by the kidneys not working properly, allowing a lot of protein to leak from the blood into the urine and failing to filter out other waste products such as sodium (salt).
The failure of the kidneys to work properly is caused by inflammation of a part of the kidney called the glomeruli allowing the leakage of proteins from the blood into the urine and stopping its ability to let sodium through. There are several conditions that can lead to this. It might be an infection, part of diabetic kidney disease, a reaction to a drug, a growth or part of an inflammatory illness affecting the whole body such as Systemic Lupus Erythematosus.
The main symptom is caused by the result of the body not cleaning out the sodium it does not require. The extra sodium holds water in the body that would normally be removed by the kidney. This water builds up, causing swelling or oedema of the ankles, legs and arms that worsens gradually.
There are two parts to the treatment. Firstly, diagnosing the condition and its cause. Secondly, giving medicines to control it and reduce the risk of it happening again.
Blood and urine specimens are obtained from the patient and sent to the laboratory. If it is Nephrotic Syndrome, the urine will show high levels of protein and the blood high levels of sodium and lipids (fats) and low levels of protein.
In addition, the Doctors will often want to perform a renal biopsy in order to obtain a very small piece of the kidney. Looking at this under the microscope will confirm the diagnosis and help them to choose the right treatment.
Any treatment will depend on the cause of the inflammation in the kidney. Some cases can be treated with steroids to reduce the inflammation in the kidney, allowing it to work normally. The swelling may take time to reduce. A relapse, where the symptoms come back, can occur.
Sometimes the inflammation is caused by the body’s own defence mechanism, the autoimmune system. Immunosuppressant drugs may be needed that reduce the power of the body’s natural defence systems long enough to allow the inflammation of the kidney to settle.
If the cause is a reaction to drugs, removing that drug from a patients prescription may help the patient to get better. Treating or removing a growth that has caused the condition will also help.
Patients with diabetic renal disease as the cause and others who do not respond to steroids are offered diuretics to control the swelling. In severe cases, these may have to be given directly into the body by injection.
Sometimes another type of drug may be given to try to reduce the amount of protein in the urine but not necessarily affecting the underlying condition.
A low sodium, high calorie diet for all Nephrotic Syndrome patients is important. Reducing salt intake will prevent swelling from getting worse and high calories will replace the lost protein. In severe cases protein may be given directly into the body by a drip.
It is important that advice given about controlling salt in you eat is put into practice in hospital and at home. Make sure your family and friends understand your needs
You will be followed up, closely, in outpatients clinics. It is important to attend these clinic appointments. If you are unable to, please let the hospital know and book another. Your Doctor will want to take blood samples regularly. This is done to check that your kidneys are working as well as they can and that your treatment is working. Your doctor will be able to tailor your treatment according to the results of the blood tests.
Relapses are not unknown. You can help by keeping an eye on your weight. If it starts to rise and you notice swelling in your legs you need to contact your doctor again. You should contact your doctor if you get the symptoms of kidney failure – tiredness, sickness, and breathlessness