Nephrotic syndrome is a kidney disorder that affects the ability of the kidneys to filter blood and retain essential proteins in the body. It occurs when the tiny filtering units of the kidneys become damaged, allowing excessive amounts of protein to leak into the urine. This leads to low protein levels in the blood and fluid accumulation in different parts of the body. Nephrotic syndrome can affect both children and adults, and its causes and severity vary depending on the patient’s age and medical condition. What Is Nephrotic Syndrome? Nephrotic syndrome is a group of clinical signs and symptoms resulting from damage to the glomeruli, which are tiny filtering structures in the kidneys responsible for removing waste products and excess fluids while retaining essential substances such as proteins. When these structures become damaged, large amounts of albumin leak into the urine. This causes low albumin levels in the blood and leads to fluid accumulation in body tissues. Causes and Risk Factors The causes of nephrotic syndrome are generally classified into primary and secondary causes. First: Primary Causes These conditions directly affect the kidneys. The most common examples include: • Minimal Change Disease: One of the most common causes of nephrotic syndrome in children. • Focal Segmental Glomerulosclerosis (FSGS): A condition characterized by scarring in some parts of the kidney’s filtering units. • Membranous Nephropathy: A disorder involving thickening of the glomerular filtration membrane. Second: Secondary Causes These develop as a result of other medical conditions that affect kidney function, including: • Diabetes mellitus, which can damage the small blood vessels in the kidneys. • Systemic Lupus Erythematosus (SLE). • Certain viral infections, such as hepatitis B, hepatitis C, and HIV. • Certain medications, particularly some nonsteroidal anti-inflammatory drugs (NSAIDs). • Other autoimmune diseases and systemic disorders. Symptoms and Clinical Signs Symptoms may vary from one patient to another. However, the most common signs include: • Swelling around the eyes, especially in the morning. • Swelling of the feet, ankles, and legs. • Abdominal swelling due to fluid accumulation. • Foamy urine caused by increased protein levels. • Weight gain resulting from fluid retention. • Fatigue and general weakness. • Reduced urine output in some cases. Diagnosis The diagnosis of nephrotic syndrome depends on several laboratory and medical investigations, including: • Urine tests to detect excessive protein levels. • Urine protein-to-creatinine ratio or a 24-hour urine protein measurement. • Blood tests to measure albumin, total protein, and kidney function. • Serum creatinine and blood urea measurements to assess kidney function. • Additional tests to identify autoimmune diseases or infections when necessary. • Kidney biopsy in selected cases to identify the underlying disease and assess the extent of kidney damage. Treatment Methods Treatment depends on the underlying cause and severity of the condition. The main goals are to reduce protein loss in the urine, control swelling, and protect kidney function. The main treatment approaches include: 1. Medical Treatment • Corticosteroids, such as prednisolone, are used in certain types of nephrotic syndrome, particularly minimal change disease. • Angiotensin-Converting Enzyme Inhibitors (ACE inhibitors) or Angiotensin Receptor Blockers (ARBs) help reduce protein loss in the urine and control blood pressure. • Diuretics help remove excess fluid from the body and reduce swelling. • Immunosuppressive medications may be prescribed in selected cases, depending on the underlying disease and the patient’s response to treatment. • Cholesterol-lowering medications may be considered when necessary, depending on lipid levels and medical assessment. 2. Dietary and Lifestyle Changes • Reducing salt intake to help prevent fluid retention. • Following a balanced and healthy diet. • Monitoring body weight and blood pressure regularly. • Adjusting fluid intake according to medical recommendations. • Avoiding medications that may harm kidney function without medical advice. Potential Complications If nephrotic syndrome is not properly managed, it may lead to several complications, including: • Increased risk of blood clots. • Elevated blood cholesterol and lipid levels. • Increased susceptibility to infections. • Malnutrition or loss of essential proteins. • Progressive kidney dysfunction, which may lead to kidney failure in some cases. Conclusion Nephrotic syndrome is a medical condition that requires early diagnosis and continuous medical follow-up to prevent complications and preserve kidney function. Identifying the underlying cause is essential for selecting the appropriate treatment and improving health outcomes. Adherence to prescribed treatment, maintaining a healthy diet, and regularly monitoring kidney function are important factors in managing the disease and improving patients’ quality of life. University of Al-Mustaqbal – The First and Leading Private University