Nephrotic syndrome is a group of symptoms that include protein in the urine, low blood protein levels in the blood, high cholesterol levels, high triglyceride levels, increased blood clot risk, and swelling.
Protein in the urine
The urine protein dipstick test measures the presence of proteins, such as albumin, in a urine sample. Albumin and protein can also be measured using...Read Article Now Book Mark Article
Swelling is the enlargement of organs, skin, or other body parts. It is caused by a buildup of fluid in the tissues. The extra fluid can lead to a ...Read Article Now Book Mark Article
Nephrotic syndrome is caused by different disorders that damage the kidneys. This damage leads to the release of too much protein in the urine.
The most common cause in children is minimal change disease. Membranous glomerulonephritis is the most common cause in adults. In both diseases, the glomeruli in the kidneys are damaged. Glomeruli are the structures that help filter wastes and fluids.
Minimal change disease
Minimal change disease is a kidney disorder that can lead to nephrotic syndrome. Nephrotic syndrome is a group of symptoms that include protein in t...Read Article Now Book Mark Article
Membranous nephropathy is a kidney disorder that leads to changes and inflammation of the structures inside the kidney that help filter wastes and fl...Read Article Now Book Mark Article
This condition can also occur from:
- Diseases such as diabetes, systemic lupus erythematosus, multiple myeloma, and amyloidosis
Diabetes is a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood.Read Article Now Book Mark Article
Systemic lupus erythematosus
Systemic lupus erythematosus (SLE) is an autoimmune disease. In this disease, the immune system of the body mistakenly attacks healthy tissue. It c...Read Article Now Book Mark Article
Multiple myeloma is a blood cancer that starts in the plasma cells in the bone marrow. Bone marrow is the soft, spongy tissue found inside most bone...Read Article Now Book Mark Article
- Genetic disorders
- Immune disorders
- Infections (such as strep throat, hepatitis, or mononucleosis)
- Use of certain drugs
It can occur with kidney disorders such as:
Nephrotic syndrome can affect all age groups. In children, it is most common between ages 2 and 6. This disorder occurs slightly more often in males than females.
Swelling (edema) is the most common symptom. It may occur:
- In the face and around the eyes (facial swelling)
- In the arms and legs, especially in the feet and ankles
- In the belly area (swollen abdomen)
Other symptoms include:
- Skin rash or sores
- Foamy appearance of the urine
- Poor appetite
- Weight gain (unintentional) from fluid retention
Exams and Tests
The health care provider will perform a physical exam. Laboratory tests will be done to see how well the kidneys are working. They include:
- Albumin blood test
- Blood chemistry tests, such as basic metabolic panel or comprehensive metabolic panel
Basic metabolic panel
The basic metabolic panel is a group of blood tests that provides information about your body's metabolism.Read Article Now Book Mark Article
- Blood urea nitrogen (BUN)
- Creatinine - blood test
- Creatinine clearance - urine test
Fats are often also present in the urine. Blood cholesterol and triglyceride levels may be high.
A kidney biopsy may be needed to find the cause of the disorder.
A kidney biopsy is the removal of a small piece of kidney tissue for examination.Read Article Now Book Mark Article
Tests to rule out various causes may include the following:
- Antinuclear antibody
- Complement levels
- Glucose tolerance test
- Hepatitis B and C antibodies
- HIV test
- Rheumatoid factor
- Serum protein electrophoresis (SPEP)
- Syphilis serology
- Urine protein electrophoresis (UPEP)
This disease may also change the results of the following tests:
The goals of treatment are to relieve symptoms, prevent complications, and delay kidney damage. To control nephrotic syndrome, the disorder that is causing it must be treated. You may need treatment for life.
Injury to the kidney and ureter is damage to the organs of the upper urinary tract.Read Article Now Book Mark Article
Treatments may include any of the following:
- Keeping blood pressure at or below 130/80 mm Hg to delay kidney damage. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are the medicines most often used. ACE inhibitors and ARBs may also help decrease the amount of protein lost in the urine.
- Corticosteroids and other drugs that suppress or quiet the immune system.
- Treating high cholesterol to reduce the risk for heart and blood vessel problems -- A low-fat, low-cholesterol diet is usually not enough for people with nephrotic syndrome. Medicines to reduce cholesterol and triglycerides (usually statins) may be needed.
- A low-sodium diet may help with swelling in the hands and legs. Water pills (diuretics) may also help with this problem.
- Low-protein diets may be helpful. Your provider may suggest a moderate-protein diet (1 gram of protein per kilogram of body weight per day).
- Taking vitamin D supplements if nephrotic syndrome is long-term and is not responding to treatment.
- Taking blood thinner drugs to treat or prevent blood clots.
Dialysis treats end-stage kidney failure. It removes waste from your blood when your kidneys can no longer do their job. There are different types o...Read Article Now Book Mark Article
A kidney transplant is surgery to place a healthy kidney into a person with kidney failure.Read Article Now Book Mark Article
Health problems that may result from nephrotic syndrome include:
- Acute kidney failure
- Hardening of the arteries and related heart diseases
- Chronic kidney disease
- Fluid overload, heart failure, fluid buildup in lungs
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...Read Article Now Book Mark Article
- Infections, including pneumococcal pneumonia
- Renal vein thrombosis
When to Contact a Medical Professional
Call your provider if:
- You or your child develops symptoms of nephrotic syndrome, including swelling in face, belly, or arms and legs, or skin sores
- You or your child are being treated for nephrotic syndrome, but symptoms don't improve
- New symptoms develop, including cough, decreased urine output, discomfort with urination, fever, severe headache
Go to the emergency room or call the local emergency number (such as 911) if you have seizures.
Treating conditions that can cause nephrotic syndrome may help prevent the syndrome.
Erkan E. Nephrotic syndrome. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 545.
Saha MK, Pendergraft WF, Jennette JC, Falk RJ. Primary glomerular disease. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 31.
Kidney anatomy - illustration
The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production.
Review Date: 7/16/2019
Reviewed By: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.