Children Nephrotic Syndrome

What is nephrotic syndrome?

Nephrotic syndrome is a kidney disease. kidneys filter our blood to remove waste products which is passed as urine. Normally only very small amounts of protein and red blood cells are passed in urine. When the child has nephrotic syndrome, he/she leaks an abnormally large amount of protein in the urine and his urine test shows protein positive. This protein in the blood is necessary to keep fluid within the blood vessels. So when due to loss in urine, protein becomes less in blood, fluid from blood seeps through blood vessel wall to soft tissue. This causes edema or swelling around eyes, face, hand, legs, genitals and abdomen.

What is its cause?

The exact cause why protein leaks in these children is not known.  However, in majority (95%) of children there is no permanent defect or kidney failure and resolves with treatment. It is not due to any infection or dietary habit. It is not infectious and does not transfer to other family member.

What is the treatment?

Most of the children unlike adults are expected to respond to treatment with steroid. So, first line of treatment is always steroid. It is only when the child does not respond to steroid almost after a month of treatment; a second drug is used. Sometimes a kidney biopsy may also be required in these children. The treatment may extend up to three to six months with time to time adjustment of dose as advised by your doctor. You can stop the drugs only when advised. The child may be given some other drugs during this treatment like diuretics i.e. drugs to increase urine output, calcium supplementation etc.

Can it recur?

Yes. Once a child develops this disease, there is very high chance that he will have it again (80%). This may happen spontaneously or sometimes due to infection. But please remember that the disease is not as such caused by infection. Usually it can occur up to 10-12 years of age

Can he have kidney failure from this?

No usually not. But there are certain conditions when he may have a more complicated disease. This will be picked up by your doctor from presence of certain signs like high B.P, hematuria, non-responsiveness to steroid therapy etc.

What are the other things we should take care of when he is under treatment? Is there any precaution we can take so that he will not have it again?

When the child is swollen and he is still passing protein in urine (relapse), he is needed to have less water, salt. Avoid high salt foods like papad, pickles, noodles, Maggie etc. He should avoid fatty food during treatment period with steroid. Preferably modify whole families by adding no salt in roti, rice, salad, curd and putting less salt in cooking food. This will not help in reducing swelling during a relapse, also in having normal blood pressure. They should have egg white, fish, have more milk and milk products.

Avoid infection by hand washing, avoiding contact with children/ adult with chicken pox, respiratory infection etc. Never stop steroid abruptly. If the child suffers from other illness while he/she is on steroid, the dose of the drug may be modified by doctor

When should one immediately consult a doctor?

If child has any of the following immediately consult doctor: fever, persistent vomiting, loose stools, lethargy, persistent cough, exposure to chicken pox. Please note that child may not have fever even at the face of severe infection

Can these children get routine vaccination?

Avoid live vaccines including oral pulse polio, MR. Certain vaccines are needed to be given after consultation with doctor.

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