Childhood Nephrotic Syndrome Assignment Writers
What is Nephrotic Syndrome?
Childhood nephrotic syndrome is a health condition that causes kidneys to release large amounts of proteins into the urine. Kidneys release these amounts of proteins because they are damaged. This condition can lead to numerous health problems such as swelling of the body tissues. It may also increase the chances of getting infections.
Nephrotic syndrome occurs when blood vessels in the kidneys are damaged by diseases forcing them to release large amounts of protein into the urine. Nephrotic syndrome can affect people in different age groups. However, it is more common in children between the age of 2-5 years.
It is also important to note that boys are more affected by this condition compared to girls. Nephrotic syndrome is more common in children born in families with a history of allergies and those of Asian ethnicity. It is not clear why this is the case.
Symptoms of nephrotic syndrome are controlled with steroid medications. Most children with this condition respond well to steroid medications and are not at risk of kidney failure. Some children have inherited nephrotic syndrome. Often, these children do not do well and are more likely to develop kidney failure that requires a kidney transplant.
Nephrotic Syndrome in Children
Children can develop both primary and secondary nephrotic syndrome. However, primary nephrotic syndrome is more common in children. In the first 3 months of life, some children may develop the congenital nephrotic disorder.
The congenital nephrotic disorder is caused by inherited genetic defects or an infection that occurs just after the baby is born. In the end, children with congenital nephrotic disorder will need a kidney transplant.
Both parents must have a faulty copy of the gene and a healthy one for them to pass on the congenital disorders to their child. Ideally what this means is that the parents do not have nephrotic syndrome but there is a 1 in 4 possibilities that their children will develop the condition.
Treatment of congenital nephrotic syndrome involves albumin infusions to help the child grow and develop normally. Children with congenital nephrotic syndrome will need hospitalization to receive treatment. In some cases, parents are trained on how to give the treatment at home.
Children with congenital nephrotic disorder need regular reviewing that involves monitoring their weight, growth, blood pressure, bone health, and kidney function. Parents and doctors should discuss the pros and cons of home-based treatment and hospital-based treatment.
During treatment, the doctor may suggest removing 1 or both kidneys to stop the loss of protein thereby reducing the risk of severe health problems such as blood clots. In cases where it is necessary to remove both kidneys, the child will need to be put on dialysis until they can receive a kidney transplant preferably from a close relative.
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Symptoms of nephrotic syndrome in children
Symptoms of nephrotic syndrome in children include;
- loss of appetite
- blood in the urine
- fatigue, fever, irritability, and other signs of infection
- high blood pressure
Children who have the nephrotic disorder are more prone to infections. The reason for this is that proteins that are supposed to protect them from infections are lost in the urine. in addition, they may have high blood cholesterol.
Symptoms of nephrotic syndrome in children are under control (remission) sometimes followed by relapses or periods when they are back. Relapses lessen as the child grows older and stop by the time they are in their late teenage years.
Symptoms of the nephrotic disorder can be described as;
- Swelling – reduced levels of protein in the blood decrease the flow of water back into blood vessels from body tissues. This causes swelling also known as edema. Edema starts around the eyes then goes to the lower legs and eventually the rest of the body.
- Changes in urine – the large amounts of protein being passed into the urine can cause the urine to become frothy. Some children may also pass fewer amounts of urine during relapses.
- Blood clots – proteins that help prevent blood clotting may be passed out in the urine. This then increases their risk of serious blood clots. Blood usually becomes more concentrated during relapses and this can cause clotting.
- Infections – antibodies that help the body fight infections are a group of proteins in the blood. When these specialized proteins are lost in the urine, children become more prone to infections.
Causes of Nephrotic Syndrome in Children
Kidneys are made of tiny blood vessels known as glomeruli. As blood flows through them, waste products and extra water are filtered into the urine. Useful substances and protein should remain in the bloodstream.
When a child has nephrotic syndrome, their glomeruli are damaged and cannot filter the blood as they are supposed to. Damaged glomeruli allow proteins to leak into the urine. One important protein lost in the process is albumin. Albumin helps to draw extra fluid from the body into the kidneys which are later removed in the urine.
When this albumin is lost in urine due to nephrotic syndrome, the body has no way of releasing the extra fluid, and instead, the body holds on to it. Accumulation of this fluid causes the face, legs, feet, and ankles to swell.
The causes of nephrotic syndrome are divided into primary causes and secondary causes.
- Primary causes of nephrotic syndrome
Some of the conditions that cause nephrotic syndrome to affect only the kidneys. Such conditions are known as the primary causes of nephrotic syndrome. These conditions are:
- Membranous nephropathy – this disease comes with the thickening of the glomeruli membrane. It is not known what causes the membrane to thicken. Thickening of the membrane may come with conditions such as cancer, lupus, malaria, or hepatitis B.
- Focal segmental glomerulosclerosis – glomeruli become scarred from a genetic defect, disease, or an unknown cause.
- Renal vein thrombosis – this disorder causes blood clots to block the vein that drains blood out of the kidney.
- Minimal change disease – people with this disease will have kidney tissues that may appear normal under a microscope although they do not filter blood properly.
- Secondary causes of nephrotic syndrome
Diseases that cause nephrotic syndrome and affect the whole body are known as secondary causes of nephrotic syndrome. These diseases include:
- Lupus – lupus is one of the autoimmune diseases that cause inflammation in the kidneys, joints, and other organs in the body.
- Diabetes – in diabetes, blood vessels all over the body may be damaged by uncontrolled blood sugar,
- Amyloidosis – this is a rare disease that is caused by the buildup of amyloid protein in the organs. When this protein buildups in the kidneys, it may cause kidney damage.
Additionally, medications used to treat infections and nonsteroidal anti-inflammatory drugs are linked to some cases of nephrotic syndrome.
Nephrotic Syndrome Risk Factors
Several things can increase the likelihood of developing nephrotic syndrome. They include;
- Specific infections – infections that increase the risk of nephrotic syndrome are malaria, HIV, and hepatitis B.
- Medications – NSAIDs, and drugs used to fight infections can increase the risk of nephrotic syndrome.
- Underlying conditions that can lead to kidney damage – conditions like kidney diseases, lupus, and diabetes are likely to increase the chances of developing nephrotic syndrome.
It is important to note that having any of these risk factors is not a sure guarantee that a person will develop nephrotic syndrome. It is important for parents to monitor the health of their children and see their doctor immediately if they notice any symptoms linked to nephrotic syndrome.
Diagnosis of Nephrotic Syndrome
During diagnosis, a dipstick is dipped in the urine sample. The dipstick will change its color if there are large amounts of protein in the sample. The diagnosis is then confirmed by a blood test that is done to show the level of albumin protein. If the test shows a low level, then the diagnosis is confirmed.
In some cases, if the initial treatment is not helpful, a kidney biopsy is done for the child. A small sample of their kidney tissue is removed using a needle and is studied under the microscope.
Management of Nephrotic Syndrome
Steroids are the main treatment for nephrotic syndrome. If the child develops severe adverse side effects, additional treatments can be used. Most children with nephrotic syndrome will experience relapses into their teens. When this happens, they should take steroids.
From time to time, the child will be referred to a childhood kidney specialist for specialist treatment and testing.
- Steroids – when a child is first diagnosed with nephrotic syndrome, the doctor will prescribe a 4-week course of prednisolone which is a steroid medicine followed by a lesser dose daily for additional 4 weeks. This will help stop the protein in the kidneys from leaking into the urine.
With prednisolone, some children might experience red cheeks, increased appetite, mood changes, and weight gain. Prednisolone causes the protein to disappear from the urine and reduces the swelling within weeks. This period is called remission.
- Diuretics – these are tablets given to reduce the buildup of fluids and work by helping the child pee more.
- Penicillin – this is an antibiotic that is prescribed during relapses to help reduce the chances of the child getting an infection.
- Dietary changes
Diet is important in the management of the nephrotic syndrome. The parent may be advised to reduce the amount of salt the child eats to help avoid swelling of the body. Avoiding salt also helps keep blood pressure in check.
Additionally, doctors may recommend a reduced intake of fluids to reduce swelling. Children with this condition should eat a diet that is low in cholesterol and saturated fats. This is because nephrotic syndrome tends to increase triglyceride and cholesterol levels. Reducing intake of the two reduces the risk of developing heart disease.
Nephrotic syndrome causes loss of protein in the urine. However, doctors do not recommend eating extra proteins to make up for the loss. This is because a diet that is high in protein can worsen the condition.
A lot of children with nephrotic syndrome have minimal change disease. Their kidneys will appear normal or nearly normal if a sample is studied under the microscope. It is not known what causes this minimal change disease.
In some cases, the nephrotic syndrome occurs as a result of kidney problems or conditions like:
- infections such as hepatitis and HIV
- glomerulonephritis (inflammation inside the kidney)
- glomerulosclerosis (scarring of the inside of the kidney)
- multiple myeloma or lymphoma and leukemia although in rare conditions
- sickle cell anemia
- Vaccinations – parents whose children have nephrotic syndrome are advised to have them receive the pneumococcal vaccine. Chickenpox vaccine may also be recommended between relapses. Live vaccines should not be given while the child is on treatment to control symptoms.
- Additional medication – sometimes other medications can be used together with steroids or in place of steroids. This is done if the child experiences adverse side effects or if remission cannot be maintained by steroids.
Additional medications that may be used include:
- Albumin infusions – albumin is the protein that is lost in nephrotic syndrome. Children with severe symptoms are usually admitted to the hospital to be given albumin infusions.
Albumin is added to the blood through a cannula over a few hours. The cannula is inserted into a vein in the arm.
Caring for the child at home
Parents whose children have been diagnosed with nephrotic syndrome will need to monitor the condition of the child every day to check for any signs of relapses. These parents will need to use dipsticks to test for protein in their child’s urine. This test is done the first time they urinate each day.
Thereafter, the parents will need to record the results of each test as they are shown by the doctor. Writing down the results for each day will help the nurse or doctor to have a review the child’s progress when they visit the hospital for outpatient appointments.
It is also important that the parents note down any medication taken by the children and add any other useful comments such as if the child was feeling unwell on any particular day. A parent can easily tell if their child is having a relapse if the dipstick shows 3+ or more protein in urine for 3 consecutive days.
In case there is a relapse, the parent should do the follow the doctor’s advice on starting steroids or if they are not able to, they should call the doctor. It is important to seek immediate medical advice if:
- the child has a fever or is unwell
- the child comes into contact with a person with measles or chickenpox and the doctor had said that the child is not immune to such illnesses.
- the child is vomiting or has diarrhea.
Complications of Nephrotic Syndrome in Children
Loss of protein from blood due to nephrotic syndrome and damage to the kidneys can cause other complications. Complications that are likely to occur in children with nephrotic syndrome are:
- blood clots – this can happen due to loss of the proteins that prevent clotting.
- high blood pressure – damage to the kidney may increase the amount of waste in the blood which can raise blood pressure.
- malnutrition – loss of protein that is in the blood can lead to weight loss. However, this complication may be hard to notice because it is masked by the swelling.
- high triglycerides and cholesterol – more triglycerides and cholesterol are released into the blood which increases the risk of heart disease.
- anemia – there may be a lack of enough blood cells to carry oxygen to tissues and organs in the body.
- acute kidney failure – if the amount of kidney damage is great, it can cause kidneys to stop filtering waste. This will need emergency medical intervention through dialysis.
- chronic kidney disease – the kidneys may be unable to function and the child may need a kidney transplant or dialysis.
- Coronary artery disease – this is the narrowing of the blood vessels which limits the flow of blood into the heart
- Underactive thyroid gland – the thyroid gland is not able to make enough thyroid hormone.
- infections – children with nephrotic syndrome are at increased risk of developing infections such as meningitis and pneumonia.
The outlook for nephrotic syndrome varies depending on the overall health of the child and the cause of the condition. Some diseases that cause nephrotic syndrome may improve on their own or with treatment.
Treating the underlying disease automatically improves the condition. On the other hand, some of these health conditions may lead to kidney failure eventually despite being treated. When this happens, the child will require a kidney transplant or dialysis.
As a parent, if your child has symptoms of nephrotic syndrome or if your child has any worrying symptoms, it is important to make an appointment with the doctor to have them checked.
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