Nephrotic syndrome in children
Overview
Nephrotic syndrome is a condition that causes the kidneys to leak large amounts of protein into the urine. This can lead to a range of problems, including swelling of body tissues and a greater chance of catching infections.
Causes
Most children with nephrotic syndrome have times when their symptoms are under control (remission), followed by times when symptoms return (relapses). In most cases, relapses become less frequent as they get older and often stop by their late teens. Some of the main symptoms associated with nephrotic syndrome include: swelling – the low level of protein in the blood reduces the flow of water from body tissues back into the blood vessels, leading to swelling(oedema). Swelling is usually first noticed around the eyes, then around the lower legs and the rest of the body.infections – antibodies are a specialised group of proteins in the blood that help to fight infection. When these are lost, children are much more likely to get infections.urine changes – occasionally, the high levels of protein being passed into the urine can cause it to become frothy. Some children with nephrotic syndrome may also pass less urine than usual during relapses.blood clots – important proteins that help prevent the blood clotting can be passed out in the urine of children with nephrotic syndrome. This can increase their risk of potentially seriousblood clots. During a relapse, the blood also becomes more concentrated, which can lead to clotting. Most children with nephrotic syndrome have "minimal change disease". This means that their kidneys appear normal or nearly normal if a tissue sample is studied under a microscope. But changes to the tissue sample can be seen if it's studied under an extremely powerful electron microscope. The cause of minimal change disease is unknown. Nephrotic syndrome can sometimes occur as a result of a kidney problem or another condition, such as: glomerulosclerosis – when the inside of the kidney becomes scarredglomerulonephritis– inflammation inside the kidneyan infection – such asHIVorhepatitislupusdiabetessickle cell anaemiain very rare cases, certain types of cancer – such asleukaemia,multiple myelomaorlymphoma These problems tend to be more common in adults with nephrotic syndrome.
Treatment
Other medications may be used alongside or in place of steroids if your child's remission cannot be maintained with steroids or they experience significant side effects. Additional medications that may be used include: levamisolecyclophosphamideciclosporintacrolimusmycophenolaterituximab