Nephrotic syndrome in children

Nephrotic syndrome is a common kidney disease in children usually occurring between the ages of 2-6 years.

In this condition there is an abnormal loss of protein in the urine (medically called as proteinuria) leading to decrease in protein level in the blood.

This results in leaking of fluid in the blood (due to decreased osmotic pressure normally exerted by proteins, which holds water inside the blood vessels) to outside the blood vessels and swelling of the whole body.

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The exact cause of the nephrotic syndrome occurring in children is not known. Routine microscopic examination of a piece kidney obtained by biopsy does not reveal any abnormality.

Hence the disease is also called as minimal change nephrotic syndrome. Electron microscopy shows some abnormality of the cells in the nephron.

Symptoms and signs: The child is brought with swelling of the body. The swelling is more marked in the face as soon as the child gets up from bed. Later in the day the swelling of the face slightly diminishes and the legs become swollen as fluid accumulates in the lower parts of the body due to gravity.

The abdomen may become distended. The child may complain of abdominal discomfort and nausea. The urine output may be decreased but unlike in glomerulonephritis the urine does not turn brownish in color. Urine may appear slightly cloudy due to the presence of excessive protein.

The diagnosis can be confirmed by examination of urine and blood. Abnormally high level of protein is found in urine while its level in the blood is reduced. The level of cholesterol in blood is increased.

Management:It may be necessary to admit the child for a few days to look for complications. Sometimes the urine output may be severely reduced requiring medication. Even though the total amount of water in the body is increased the water content inside the blood vessels is reduced. This results in thickening of blood and occasionally clotting of blood inside blood vessels.

Majority of children respond to treatment with steroids. Prednisolone is the medicine recommended initially to all the patients of nephrotic syndrome. To start with, the medicine is given in divided doses three times daily and later once on alternate days.

It is usually enough to give this treatment for a total period of twelve weeks. Urine is tested regularly to assess the progress.

Majority of children respond to this treatment and do not have any problem. However some children have a relapse, which can be frequent or infrequent.

Some children show signs of relapse when alternate day Prednisolone therapy is started. Such children are called as steroid dependant and need medication for a longer period.

A small percentage of children fail to respond to this treatment and require other drugs. They are called as steroid resistant. These children need biopsy of the kidney to make the correct diagnosis.

When a child is on Prednisolone he will put on some weight and develop a rounded appearance of the face. This gradually disappears after treatment is stopped. This drug lowers the immunity of the child and hence the child becomes prone to infections.

If a child who is on Prednisolone gets fever, cough or abdominal pain he should be immediately shown to a doctor. When there is a doubt it may be necessary to carry out a few investigations like X-ray to rule out or confirm tuberculosis.

In general the outlook for children with nephrotic syndrome is good. It is usually completely curable and does not cause any long- term problem.

Page last reviewed on 19th November 2009

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