Nephrotic syndrome is a serious kidney condition that affects both children and adults, often silently at first. Many people first notice it due to swelling in the face, legs, or abdomen, without realizing that the kidneys are at the root of the problem. In India, nephrotic syndrome is one of the most common kidney disorders seen in children, but adults are increasingly affected as well.

The condition is not a single disease but a group of symptoms that occur when the kidneys are damaged and begin leaking excessive amounts of protein into the urine. Without proper treatment, nephrotic syndrome can lead to infections, blood clots, kidney failure, and long-term health complications.

Understanding what nephrotic syndrome is, why it happens, and how it is treated can help patients and families manage the condition effectively and avoid serious outcomes.

What Is Nephrotic Syndrome?

Nephrotic syndrome occurs when the filtering units of the kidneys, called glomeruli, are damaged. These filters normally prevent important proteins from leaving the blood. When damaged, they allow protein—especially albumin—to pass into the urine.

This protein loss leads to:

• Low protein levels in the blood

• Fluid leakage into body tissues

• Swelling (edema)

• Increased risk of infections and clotting

Nephrotic syndrome is diagnosed based on a combination of symptoms, urine findings, and blood tests.

Why Protein Loss Is Dangerous

Protein plays a vital role in maintaining fluid balance, immunity, and overall health. When large amounts of protein are lost through urine:

• Fluid shifts from blood vessels into tissues, causing swelling

• The immune system weakens, increasing infection risk

• Blood becomes more prone to clotting

• Cholesterol levels rise abnormally

This explains why nephrotic syndrome affects the whole body, not just the kidneys.

Common Symptoms of Nephrotic Syndrome

Symptoms may develop gradually or appear suddenly. Some signs are subtle and often ignored initially.

Key Symptoms Include:

• Swelling around eyes, especially in the morning

• Swelling of feet, ankles, legs, or abdomen

• Foamy or frothy urine due to protein

• Sudden weight gain from fluid retention

• Fatigue and weakness

• Reduced urine output in some cases

In children, facial puffiness is often the first noticeable sign, while adults may notice leg swelling or abdominal bloating.

Causes of Nephrotic Syndrome

Nephrotic syndrome can occur due to primary kidney diseases or as a result of other medical conditions.

Primary Causes (Affecting the Kidneys Directly)

These involve diseases that damage the kidney filters:

• Minimal change disease (common in children)

• Focal segmental glomerulosclerosis

• Membranous nephropathy

These conditions alter the structure of the kidney filters, leading to protein leakage.

Secondary Causes (Related to Other Conditions)

Some systemic diseases can damage kidneys over time:

• Diabetes

• Autoimmune disorders

• Chronic infections

• Long-standing high blood pressure

• Certain medications

In adults, secondary causes are more common and often require long-term management.

Nephrotic Syndrome in Children vs Adults

In Children

• Most common kidney disorder in childhood

• Often responds well to treatment

• Relapses may occur

• Long-term outlook is usually good

In Adults

• Often linked to underlying diseases

• Slower response to treatment

• Higher risk of complications

• Requires closer monitoring

Understanding age-related differences helps guide treatment decisions.

How Nephrotic Syndrome Is Diagnosed

Diagnosis involves confirming protein loss and identifying the underlying cause.

Common Diagnostic Tests Include:

• Urine tests to measure protein levels

• Blood tests to check protein, cholesterol, and kidney function

• Blood pressure monitoring

• Imaging studies if needed

• Kidney biopsy in selected cases

Early diagnosis is essential to prevent irreversible kidney damage.

Treatment of Nephrotic Syndrome

Treatment focuses on:

• Reducing protein loss

• Managing symptoms

• Treating the underlying cause

• Preventing complications

There is no one-size-fits-all approach. Treatment is individualized based on age, cause, and response.

1. Medications

Medicines play a central role in treatment:

• Drugs to reduce kidney inflammation

• Medicines to control swelling

• Blood pressure–lowering agents to protect kidneys

• Cholesterol-lowering medications

• Medications to reduce clotting risk

In children, treatment often leads to remission, though relapses can occur.

2. Dietary Management

Dietary changes are crucial for symptom control:

• Reduced salt intake to manage swelling

• Adequate protein intake (not excessive)

• Balanced nutrition to support immunity

• Fluid management when swelling is severe

Diet plans should always be individualized.

3. Managing Swelling and Fluid Retention

Swelling is one of the most uncomfortable symptoms. Management includes:

• Salt restriction

• Careful fluid balance

• Monitoring body weight daily

Proper management improves comfort and prevents complications.

4. Preventing Infections

Protein loss weakens the immune system. Preventive care includes:

• Timely vaccinations

• Early treatment of infections

• Maintaining good hygiene

Infections can trigger relapses, especially in children.

5. Long-Term Monitoring

Nephrotic syndrome requires ongoing follow-up:

• Regular urine testing

• Blood pressure monitoring

• Kidney function assessment

• Monitoring growth in children

Long-term care helps detect relapses early and protect kidney health.

Possible Complications If Left Untreated

Without proper management, nephrotic syndrome can lead to:

• Recurrent infections

• Blood clots

• Severe fluid overload

• Malnutrition

• Chronic kidney disease

• Kidney failure

Early and consistent treatment significantly reduces these risks.

Living With Nephrotic Syndrome

A diagnosis of nephrotic syndrome can be emotionally challenging, especially for parents of affected children. With proper treatment and lifestyle adjustments:

• Many patients live normal, active lives

• Children can attend school and play normally

• Adults can continue working with medical supervision

Education, awareness, and adherence to treatment are key to long-term success.

Early Care Makes a Lasting Difference

Nephrotic syndrome is a manageable condition when diagnosed early and treated correctly. While it may require long-term monitoring, most patients can maintain good quality of life with proper medical care and lifestyle adjustments.

Ignoring early signs like swelling or foamy urine can lead to serious kidney damage. Awareness and timely treatment remain the strongest tools in protecting kidney health.

FAQ

1. Is nephrotic syndrome a lifelong condition?

Not always. Many children experience remission, though relapses may occur. In adults, it depends on the underlying cause and response to treatment.

2. Can nephrotic syndrome lead to kidney failure?

Yes, if left untreated or poorly controlled, it can progress to chronic kidney disease or kidney failure.

3. Is nephrotic syndrome contagious or hereditary?

No, it is not contagious. Some forms may have genetic links, but most cases are not inherited.