Nephrotic syndrome overview

Overview

Nephrotic syndrome is a kidney problem that makes your kidneys leak too much protein into your urine. This causes swelling in your body, especially around your eyes, feet, and belly. It also leads to low protein in your blood and high cholesterol. It is not a disease itself, but a set of symptoms that can be treated.

Nephrotic syndrome is not common. It affects about 2 to 7 children out of 100,000 each year. In adults, it is less common, especially with other health conditions like diabetes.

It affects mostly children between ages 2 and 6, and more boys than girls. Adults can also get it, and it is slightly more common in men. Anyone with kidney problems or conditions like diabetes or lupus may be at higher risk.

Symptoms

Common symptoms

• Swelling around the eyes in the morning
• Swelling in the feet, ankles, or legs
• Swelling in the belly (abdomen)
• Foamy or bubbly urine
• Weight gain from fluid buildup
• Feeling very tired
• Loss of appetite

Symptoms in children

• Swelling around the eyes, especially in the morning
• Irritability and fussiness
• Eating less than usual
• Less active than normal

Symptoms in older adults

• Swelling in the legs and feet that may be more severe
• Fatigue and weakness
• Shortness of breath if fluid builds up in the lungs
• Often linked to other health problems like diabetes

Causes

Main causes

• Minimal change disease (most common in children)
• Focal segmental glomerulosclerosis (FSGS)
• Membranous nephropathy
• Diabetic kidney disease
• Lupus (systemic lupus erythematosus)
• Amyloidosis
• Certain infections (like strep throat or hepatitis)
• Some medications (e.g., nonsteroidal anti-inflammatory drugs, certain antibiotics)

Risk factors

• Being a young child (especially age 2–6)
• Having diabetes or high blood pressure
• Having an autoimmune disease like lupus
• Family history of kidney disease
• Having had a recent infection like strep throat

When to see a doctor

See a doctor urgently if:

• If you notice swelling around your eyes, feet, or ankles
• If your urine looks foamy or bubbly
• If you gain weight quickly over a few days without overeating
• If you have shortness of breath or feel very tired

Book a routine appointment if:

• If you have high blood pressure or protein in your urine during a routine checkup
• If you have a condition that increases your risk (like diabetes or lupus)
• For follow-up visits after starting treatment

Diagnosis

Your doctor will start by asking about your symptoms and medical history. They will order urine and blood tests to look for protein and check your kidney function.

Tests that may be done

• Urine dipstick test – checks for protein in a small sample
• 24-hour urine collection – measures exact amount of protein lost
• Blood tests – check levels of albumin (protein), cholesterol, and creatinine (kidney function)
• Kidney biopsy – a small piece of kidney is taken to look at under a microscope, often needed for adults

What to expect at your appointment

Your doctor will explain the test results and what they mean. You may be referred to a kidney specialist (called a nephrologist). Diagnosis usually involves several visits to confirm the findings and plan treatment.

Treatment

Treatment focuses on reducing protein leakage, controlling swelling, and preventing complications. It also aims to treat any underlying cause. Most people need a combination of medication and lifestyle changes.

Self-care at home

• Monitor your weight daily to check for fluid buildup
• Eat a low-salt diet to help control swelling
• Stay active with gentle exercise like walking
• Get plenty of rest when you feel tired
• Avoid close contact with people who are sick to prevent infections

Medical treatments

Doctors often prescribe medications that reduce inflammation and calm the immune system, such as corticosteroids (like prednisone) or other immunosuppressants. They may also give diuretics (water pills) to help your body get rid of extra fluid, and medicines to lower blood pressure or cholesterol. Always take medications exactly as prescribed and never stop without talking to your doctor.

When is surgery considered?

Surgery is not usually needed to treat nephrotic syndrome. In rare cases, a kidney biopsy may be done, but that is a procedure, not a surgery. If kidney failure develops, dialysis or a kidney transplant might be considered, but that is a separate situation.

Living with this condition

Living with nephrotic syndrome means keeping track of your symptoms, taking medications regularly, and visiting your doctor for checkups. You may need to monitor your weight and watch for swelling. Many people learn to manage their condition and continue with their daily routines.

Lifestyle tips

• Cut down on salt – avoid processed foods and salty snacks
• Maintain a healthy weight
• Do not smoke – smoking harms kidneys
• Limit alcohol to stay within recommended guidelines
• Stay up to date on vaccines, especially flu and pneumonia shots

Diet and exercise

A low-salt diet is key to control swelling. Your doctor may also suggest limiting fluids if swelling is severe. Eat a balanced diet with plenty of fruits, vegetables, whole grains, and lean protein. Gentle exercise like walking or swimming can help you stay healthy. Talk to your doctor before starting any intense exercise.

Mental health and emotional wellbeing

Living with a chronic condition can be stressful. You may feel anxious, sad, or frustrated. It is normal to have these feelings. Talk to your doctor or a counsellor. If you ever feel overwhelmed or have thoughts of harming yourself, call a crisis support line right away.

Prevention

There is no sure way to prevent nephrotic syndrome because most cases happen for unknown reasons. However, controlling conditions like diabetes and high blood pressure, and avoiding infections where possible, may reduce your risk.

Vaccines

Vaccines are important because infections can trigger a relapse or worsen symptoms. It is recommended to get the flu vaccine every year and the pneumococcal vaccine to protect against pneumonia. Talk to your doctor about which vaccines are right for you.

Screening programmes

Routine screening with urine tests is not usually done for the general public. However, if you have a family history of kidney disease or a condition like diabetes, your doctor may check your urine for protein as part of a regular checkup.

Complications

If left untreated

• Infections (like peritonitis or pneumonia)
• Blood clots in the legs or lungs
• Kidney damage leading to chronic kidney disease or kidney failure
• Severe fluid buildup causing shortness of breath
• High cholesterol and poor nutrition

Long-term outlook

With proper treatment, most people with nephrotic syndrome do well. Children often respond very well and may outgrow it by their teens. Adults can also be effectively managed, though they may need longer treatment. Regular follow-up helps prevent complications and maintain kidney health. Many people live full, normal lives.

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