Nephrotic syndrome in childhood

Nephrotic syndrome is a disease of the kidneys which occurs in childhood. It is often called nephrosis or minimal change disease, and is a disease which is characterized by increased leakage of proteins from the body in the urine. This results in increased levels of protein present in the urine and low levels of protein present in the blood. Which in turn will cause fluid present in the blood to move into and within the body tissues, resulting in swelling or edema of the tissues. This swelling is especially apparent around your child’s eyes, in the face, in the abdomen which is known as ascites and in the legs. You will be able to notice this swelling as weight gain in the child, and you may also notice that your child does not pass urine as frequently as he/she used to.

This type of protein leak and edema is not specific to nephrotic syndrome alone, and can be seen with other diseases of the kidney as well such as glomerulonephritis.

What is the cause of nephrotic syndrome?

There are variety of causes of nephrotic syndrome, but the most common type to affect children is known as Idiopathic, meaning that an identifiable cause has not been recognized yet.  Idiopathic nephrotic syndrome is much more common in boys than in girls and affects children in the age range of 1 ½ to 5 years.

Symptoms of nephrotic syndrome:

You should suspect that your child may be suffering from nephrotic syndrome, if they develop some of the following:

• Facial edema and puffiness around the eyes, which is initially present only in the mornings and gradually begins to appear throughout the day.
• Abdominal pain and swelling
• Frothy urine
• Increased body weight
• Malaise and fatigue
• Loss of appetite
• Paleness of the nail bed

How can nephrotic syndrome be treated?

The mainstay of treatment for nephrotic syndrome is a daily dose of steroids, prednisolone, which is given according to your child’s body weight, with the aim of reducing the loss of protein in the urine, and making sure that your child is passing an adequate volume of urine.

How does prednisolone act?

It acts by stopping the leakage of protein from the kidney and into the urine. It also helps your child pass urine more often, which means that gradually more and more fluid is passing out of the body and the swelling will go down after a few weeks of treatment.

Although known to be very effective in the treatment of nephrotic syndrome, prednisolone can have side effects when large doses are used for long periods of time, such as:

• Increased appetite
• Low immunity and high risk of infection
• Weight gain
• Fluctuation of mood
• Poor growth rate
• Hyper activity
• Development of acne

Is there any other form of treatment for nephrotic syndrome?

In the case that prednisolone does not have any effect on your child’s symptoms, then the doctor may prescribe more potent medication known as immunosuppressive drugs. These act by lowering the immunity in your body, therefore your child will be more susceptible to infections and also have other side effects like loss of hair and reduced production of blood cells. Therefore you must always discuss treatment options in detail with your doctor before commencing. Your child may require vaccination against conditions like chicken pox prior to commencing treatment.

What happens during treatment?

Once your child has been started on any form of treatment it is important that he/she is closely monitored for response and relapses. This monitoring can be done even at home, using a simple urine protein test, which will indicate the level of protein present in the urine. If the urine protein continues to reduce, then the doctor will suggest weaning off the steroid dose.

But if the home urine protein test shows 2+ protein levels or more, for three consecutive days, then you should promptly inform your doctor about this, because it may mean that your child is relapsing. During these relapses, it is important for you to restrict the fluid and salt intake of your child, because increased levels of salt and fluid can further aggravate the condition.

Will the disease flare up again?

When it comes to childhood nephrotic syndrome, it is common for children to relapse frequently, which is about 3-4 times a year, especially within the first two years after the onset of the disease. The lesser the relapses a child suffers, better the outcome of the disease, although nephrotic syndrome in childhood is not known to cause permanent kidney damage or altered kidney function. And the natural progression of the disease is such that the child usually outgrows it as they approach adulthood, with relapses occurring less frequently as they grow older, and going into complete remission when they are adults.