Nephrotic syndrome in children

THE kidneys are important organs in the body that perform the essential function of filtering and removing waste products from the body and regulating water, salt and mineral levels.

Kidney disease can affect children in various ways and can be caused by birth defects, infections, hereditary diseases, trauma, nephrotic syndrome, urinary obstruction and systemic diseases. Paediatrician Dr Lim Kang Yaik (pic) answers some questions regarding this matter:

What is nephrotic syndrome?

Nephrotic syndrome is a collection of symptoms that happens when the glomeruli (tiny filtering units in the kidneys) do not work properly, resulting in the release of too much protein into the urine.

When this happens, the water from the blood is drawn into the body tissues and causes swelling, especially on the feet, ankle, face and around the eyes. The urine will become foamy. It affects more boys than girls and is usually diagnosed between the ages of two and five.

What causes childhood nephrotic syndrome?

In children, the most common cause is minimal change disease. It involves damage to the glomeruli that can only be seen with an electron microscope. The exact cause of minimal change is still unknown.

Nephrotic syndrome can also be caused by other primary kidney diseases or result from systemic diseases such as diabetes mellitus and lupus that affect multiple organs including the kidneys.

How do I test for nephrotic syndrome?

A preliminary test called urine dipstick for albumin can help in detecting the presence of albumin in the urine. Blood test can be performed to measure the protein level and assess the kidney function. Additional tests may be done based on individual cases.

What is the treatment for nephrotic syndrome?

The treatment depends on the cause. The first line treatment for minimal change disease nephrotic syndrome is a course of steroids. In most cases, this will stop the protein leakage.

However, these children are very prone to experience a relapse (the symptoms return) later. The parents will be taught to monitor the condition at home using a urine dipstick.

Patients may also be given medication (diuretic) to produce more urine to help reduce fluid retention in the body. Antibiotic may be prescribed during the initial period to reduce the chances of an infection. It is recommended to have a normal protein diet and limit the intake of salt.

What is the long-term outlook for nephrotic syndrome?

The outlook is good for children who respond well to steroid treatment. In most cases, it will eventually go away in late childhood. Those who do not respond to steroid treatment will need a kidney biopsy for further treatment.

■ This article is contributed by KPJ Selangor Specialist Hospital

KKLIU No.0140/2018