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Wednesday, 17 August 2011 10:52

Nephrotic Syndrome: ‘Swelling of Legs’

I have swelling in my legs when I get back home in the evening.  In the morning, some swelling is sometimes seen around the eyes when I get up. Do I need to worry about it??

What is Nephrotic syndrome?

Nephrotic syndrome is a condition marked by-

  • Very high levels of protein in the urine, a condition called proteinuria
  • Low levels of protein in the blood
  • Swelling, especially around the eyes, feet, and hands
  • High cholesterol

 What causes Nephrotic syndrome?

Nephrotic syndrome results from damage to the kidneys' glomeruli—tiny blood vessels that filter wastes and excess water from the blood and send them to the bladder as urine.

When the glomeruli are working properly, they keep protein in the blood from leaking into the urine. Healthy kidneys allow less than 150 mg/day protein to escape through the urine in a day. In Nephrotic syndrome, the damaged glomeruli allow 3 grams or more of protein to leak into the urine during a 24-hour period.

As a result of this protein loss, the blood is deficient. Normal amounts of blood protein are needed to help regulate fluid throughout the body. Protein acts like a sponge to soak up fluid into the bloodstream. When blood is low in protein, fluid accumulates in the body’s tissues rather than circulating. The fluid causes swelling and puffiness.

Nephrotic syndrome can occur with many diseases. In adults, the most common causes are diabetic nephropathy and membranous nephropathy. In older adults, the most common cause is amyloidosis. Prevention of Nephrotic syndrome relies on controlling these diseases. Frequently, however, the cause of Nephrotic syndrome is unknown.

How is Nephrotic syndrome diagnosed?

Your doctor will need blood and urine samples to evaluate your condition.

A high level of protein in a spot urine sample may indicate Nephrotic syndrome. The doctor may order a 24-hour collection of urine in order to get a more precise measurement. Blood tests may show low levels of protein

Once Nephrotic syndrome is established, the doctor may recommend a kidney biopsy—a procedure in which tiny pieces of the kidney are removed for examination with a microscope. The biopsy may reveal the underlying disease so that the doctor can determine a course of treatment. If a person has had diabetes for some time, and the patient history and laboratory tests are consistent with diabetic nephropathy, a biopsy is rarely necessary. Generally patients fear the procedure of biopsy, but in good hands and at specialized kidney centers, the risk of any complication is negligible and the procedure can be done as day care procedure. If biopsy is delayed or correct diagnosis is not reached then the kidney can progressively get damaged. If kidney damage is advanced, waste products such as creatinine and urea nitrogen may build up in the blood.

How is Nephrotic syndrome treated?

In addition to addressing the underlying cause, treatment of Nephrotic syndrome focuses on reducing high cholesterol, blood pressure, and protein in urine through diet, medications, or both. Two groups of blood pressure medications—angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)—also protect the kidneys by reducing proteinuria. Some people may benefit from limiting protein in their diet to reduce the buildup of wastes in the blood.

Nephrotic syndrome may go away once the underlying cause, if known, has been treated. In children, 80 percent of cases of Nephrotic syndrome are caused by a condition called minimal change disease, which can be successfully treated with prednisone. However, in adults, most of the time the underlying cause is a kidney disease such as membranous nephropathy or focal segmental glomerulonephritis, diseases that are treated with corticosteroids, immunosuppressive drugs, and, in some cases, cytotoxic agents.

Unfortunately, these treatments do not always bring about remission of Nephrotic syndrome. Depending on the disease, as many as half of the patients may develop chronic kidney disease that progresses to end-stage renal disease. In these cases, the kidneys gradually lose their ability to filter wastes and excess water from the blood. If kidney failure occurs, the person will need dialysis or a kidney transplant. To prevent this, an early and correct diagnosis and management of the patient is necessary.


Last Updated on Wednesday, 17 August 2011 15:04



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He needed surgery to correct the same.

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