Older people can be cursed with puffy eyes – but it affects young

Puffy eyes are the bane of those people obsessed with keeping their youthful looks, if fashion magazine front covers are anything to go by.

“Get rid of puffy eyes NOW!” they command.

Who am I to judge? Go for it, if you care about that sort of thing and want to waste your money on anti-ageing creams.

I’m reminded of a five-year-old patient who was brought in to see me by her parents a few months ago.

I gave her some antihistamines because her eyes looked like they were showing a reaction to hay fever – it was the season, after all.

Her eyes weren’t too itchy and she wasn’t sneezing much, but an allergy seemed the most likely cause.

A couple of days later the family was back.

Despite the antihistamines her puffy eyes were worse. Something else was going on. We did a quick pee test which detected something unusual – a high level of protein in her urine.

This pointed towards nephrotic syndrome, a condition where kidneys become “leaky”.

Kidneys are like filters which help clear waste from the body, and one of the things they should retain is protein, which is used to build and repair tissue.

This condition sees large amounts of protein leak from the bloodstream into the urine.

It can affect people of various ages, including children. Among younger people, it’s usually because of a condition called minimal change disease.

That’s because when we look at a sample of kidney tissue under the microscope it looks pretty normal.

There can be other causes of nephrotic syndrome, like other kidney conditions, diabetes or rheumatoid arthritis, and if it’s left untreated it can cause tiredness, diarrhoea and wasting of the muscles.

But the main symptom is fluid retention, which happens because of the low protein level in the blood.

This caused puffy eyes in my young patient, but in older folk manifests as swollen ankles.

Much like puffy eyes commonly being due to allergy though, most cases of swollen ankles are not due to nephrotic syndrome.

As for my young patient, I sent her to the kidney doctor for specific treatment. A course of steroids usually works well – and the outlook is good.