Nephrotic syndromeNNephrotic syndromeNephrotic syndromeEnglishNephrologyChild (0-12 years);Teen (13-18 years)KidneysKidneysConditions and diseases;SymptomsAdult (19+) CaregiversNA2020-01-23T05:00:00ZJosefina Brooke, RN, BScN, CNeph(C); Seetha Radhakrishnan, MDCM, FRCPC, MScCH; Ashley McNaughton, RN, BScN10.500000000000042.30000000000001531.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Nephrotic syndrome is one of the most common kidney diseases in children. It presents as a group of symptoms, which occur together in the body and include the presence of protein (albumin) in the urine and edema (swelling).</p><p>Nephrotic syndrome is a rare kidney condition that occurs in about five in 100,000 children worldwide. It is diagnosed when proteinuria (high levels of protein in the urine), hypoalbuminemia (low levels of albumin in the blood), and edema (swelling) are all present together in the body. Most children with nephrotic syndrome get better with treatment and experience no long-term kidney problems.</p><h2>What is nephrotic syndrome?</h2> <figure class="asset-c-80"> <span class="asset-image-title">Nephrotic syndrome</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/NephroticSyndrome_ProteinLeakage_Combined_EN.jpg" alt="The glomeruli in nephrotic syndrome allow protein to leak into the urine." /><figcaption class="asset-image-caption">The glomerulus (plural: glomeruli) of the kidney is a minuscule cluster of tiny blood vessels involved in filtering blood to form urine (pee). In nephrotic syndrome, the glomerulus allows protein to leak into the urine.</figcaption></figure> <h3>Proteinuria</h3><p>Proteinuria is when there are high levels of protein in the urine. Normally, there is little to no protein found in urine. In nephrotic syndrome, the glomeruli (the filters within the kidney) leak protein from the blood that flows through them into the urine they produce.</p><h3>Hypoalbuminemia</h3><p>Hypoalbuminemia is when low levels of protein (albumin) are found in the blood. When a large amount of protein leaks out into the urine, the body cannot make enough new protein to keep up. This results in hypoalbuminemia.</p><h3>Edema</h3><p>Edema happens in nephrotic syndrome because of low protein levels in the blood. Protein normally acts like a sponge to keep fluid in the blood vessels. With less protein in the blood, fluid leaks out of the blood vessels into other tissues. Edema is typically seen around the eyes, face and legs. Fluid can also build up in the abdomen, around the genital area or in the lungs.</p><h2>Key points</h2><ul><li>Nephrotic syndrome is a condition that occurs when proteinuria, hypoalbuminemia, and edema are present in the body.</li><li>The cause of nephrotic syndrome is still unknown.</li><li>Your health-care provider will ask for a urine sample and a blood test to diagnose nephrotic syndrome.</li><li>Steroid medications are used to treat nephrotic syndrome.</li><li>Most children respond well to treatment and will have excellent long-term outcomes.</li></ul><h2>Signs and symptoms</h2><p>When a child first presents with nephrotic syndrome, they may be irritable and have swelling around the eyes, abdomen, lower legs and sometimes the genitals.</p><p>You may also note the following changes in your child:</p><ul><li>Weight gain because of fluid retention</li><li>Less frequent urination (peeing) or foamy urine</li><li>Abdominal pain or discomfort</li><li>Diarrhea (loose stools) and/or vomiting</li><li>Feeling generally unwell and tired</li></ul><h2>Causes of nephrotic syndrome</h2><p>Most nephrotic syndrome in children is idiopathic, meaning that the cause of nephrotic syndrome is unknown. Nephrotic syndrome is more common in boys than girls, and often appears for the first time in children under five years of age.</p><p>The most common types of nephrotic syndrome in children are minimal change disease and focal segmental glomerulosclerosis (FSGS).</p><p>Rarely, some patients have nephrotic syndrome in the first few months of life. In these cases, the cause is most likely genetic, meaning that the glomeruli did not develop normally before birth.</p><h2>Diagnosis</h2><p>Diagnosis is made by testing the urine for proteinuria, and the blood for hypoalbuminemia, in the presence of edema. The disappearance of protein in the urine after the use of prednisone helps to confirm the diagnosis of nephrotic syndrome. Sometimes, the doctor may also recommend a <a href="/Article?contentid=35&language=English">kidney biopsy</a> to help with the diagnosis and treatment of nephrotic sydrome.</p><h2>Treatment of nephrotic syndrome</h2><p>The goal of treatment is to stop the kidneys from leaking protein into the urine. The initial treatment of nephrotic syndrome is with <a href="/Article?contentid=111&language=English">prednisone or prednisilone</a>, which is taken every day for at least six weeks and then slowly decreased over several months. Steroids work in many different ways for nephrotic syndrome, but the exact way they work is not known. It is important to continuously take prednisone as instructed without stopping suddenly. Sometimes, this first course of treatment is all that is needed. However, for some children, the disease can return, which requires further treatment.</p><p>Prednisone usually works very well to treat nephrotic syndrome. Most children respond to prednisone; however, a small number of children do not. In these cases, a <a href="/Article?contentid=35&language=English">kidney biopsy</a> may be required. Some children may need to take other medications that suppress the immune system, such as <a href="/Article?contentid=114&language=English">cyclophosphamide</a>, <a href="/Article?contentid=245&language=English">tacrolimus</a>, <a href="/Article?contentid=196&language=English">mycophenolate</a> or rituximab.</p><p>If there is severe edema, your child may need to be admitted to the hospital to receive protein (albumin) intravenously. Your child may also be given a diuretic (“water pill”) to help remove some of the extra fluid that has accumulated in the body. It is very important for a child with nephrotic syndrome to eat a low-salt diet to prevent fluid retention. Consuming more protein in the diet will have no effect and is not recommended. While on prednisone, it is also important to eat a <a href="/Article?contentid=1201&language=English">low-salt and low calorie diet</a>.</p><p>While on steroid medication, your child is at higher risk of infection. Seek immediate medical attention if your child shows signs of fever or other signs of infection. Let your dentist know that your child is on steroids, and speak to your health-care team before giving any vaccinations.</p><h2>Complications</h2><p>Hyperlipidemia (high levels of blood cholesterol and triglycerides) is a common consequence of nephrotic syndrome. If albumin levels are low due to leakage, the balance of various fats in the body is altered, which leads to high levels of cholesterol. This is usually temporary and does not cause long-term harm, as cholesterol levels normally re-balance with treatment.</p><p>If nephrotic syndrome is left untreated, complications such as infection, fluid overload (significant swelling causing discomfort), kidney injury and blood clots can occur.</p><h2>When to call your health-care provider</h2><ul><li>If your child has chicken pox, or has direct contact with someone who has chicken pox, while on prednisone.</li><li>If urine becomes positive for protein again.</li></ul><p>Take your child to the nearest emergency department if your child:</p><ul><li>is swollen</li><li>is unwell with a fever</li><li>has a persistent headache</li><li>has vomiting or abdominal pain and/or decreased urine output</li></ul><h2>Resources</h2><p>The Kidney Foundation of Canada (<a href="https://www.kidney.ca/">www.kidney.ca</a>)</p><p>NephCure® Kidney International (<a href="https://nephcure.org/">www.nephcure.org</a>)</p><h2>References</h2><p>Childhood Nephrotic Syndrome: A Guide for the Parents on the Management and Treatment of Childhood Nephrotic Syndrome. <em>The Kidney Foundation of Cananda</em>. Retrieved from <a href="https://www.kidney.ca/document.doc?id=330">https://www.kidney.ca/document.doc?id=330</a>.</p><p>Downie ML, Gallibois C, Parekh RS, Noone DG (2017). Nephrotic syndrome in infants and children: pathophysiology and management. <em>Paediatr Int Child Health, 37(4)</em>, 248-258.</p><p>Banh TM, Hussain-Shamsy N, Patel V, Vasilevska-Ristovska J, Borges K, Sibbald C, Lipszyc D, Brook, J, Geary D, Langlois V, Reddon M, Pearl R, Levin L, Piekut M, Licht C, Radhakrishnan S, Aitken-Menezes K, Harvey E, Hebert D, Piscione T, Parekh RS (2016). Ethnic differences in incidence and outcomes of childhood nephrotic syndrome. <em>Clin J Am Soc Nephrol, 11(10)</em>, 1760-1768.</p>
Syndrome néphrotiqueSSyndrome néphrotiqueNephrotic syndromeFrenchNephrologyChild (0-12 years);Teen (13-18 years)KidneysKidneysConditions and diseases;SymptomsAdult (19+) CaregiversNA2020-01-23T05:00:00ZJosefina Brooke, RN, BScN, CNeph(C); Seetha Radhakrishnan, MDCM, FRCPC, MScCH; Ashley McNaughton, RN, BScN1780.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Le syndrome néphrotique est l'une des maladies rénales les plus courantes chez les enfants. Il se présente sous la forme d’un groupe de symptômes, qui apparaissent ensemble dans l’organisme et comprennent la présence de protéines (albumine) dans l’urine et un œdème (gonflement).</p><p>Le syndrome néphrotique est une maladie rénale rare qui touche environ 5 enfants sur 100 000 dans le monde. On la diagnostique en présence d’une protéinurie (taux élevé de protéines dans l’urine), d’une hypoalbuminémie (faible taux d’albumine dans le sang) et d’un œdème (gonflement) simultanés dans l’organisme. La plupart des enfants atteints du syndrome néphrotique se rétablissent après le traitement et n’ont pas de problèmes de rein à long terme.</p><h2>Qu’est-ce que le syndrome néphrotique?</h2> <figure class="asset-c-80"> <span class="asset-image-title">Syndrome néphrotique</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/NephroticSyndrome_ProteinLeakage_Combined_FR.jpg" alt="The glomeruli in nephrotic syndrome allow protein to leak into the urine." /><figcaption class="asset-image-caption">Les glomérules sont de très petits amas de minuscules vaisseaux sanguins qui servent à filtrer le sang pour produire l’urine (le pipi). En présence du syndrome néphrotique, le glomérule laisse les protéines s’échapper dans l’urine.</figcaption></figure> <h3>Protéinurie</h3><p>Par protéinurie, on entend la présence d’un taux élevé de protéines dans l’urine. Normalement, on détecte peu ou pas de protéines dans l’urine. Chez une personne atteinte du syndrome néphrotique, les glomérules (les filtres à l’intérieur du rein) laissent les protéines du sang qui les traverse s’infiltrer dans l’urine qu’ils produisent.</p><h3>Hypoalbuminémie</h3><p>Par hypoalbuminémie, on entend la présence d’un faible taux de protéines (albumine) dans le sang. Lorsqu’une grande quantité de protéines s’écoule dans l’urine, l’organisme ne peut pas produire suffisamment de nouvelles protéines pour suivre le rythme. Il en résulte une hypoalbuminémie.</p><h3>Œdème</h3><p>Un œdème se produit en cas de syndrome néphrotique en raison du faible taux de protéines dans le sang. Normalement, les protéines agissent comme une éponge pour conserver le fluide à l’intérieur des vaisseaux sanguins. Lorsque le sang contient moins de protéines, le liquide s’échappe des vaisseaux sanguins vers d’autres tissus. L’œdème se manifeste généralement autour des yeux, au visage et aux jambes. Le liquide peut également s’accumuler dans l’abdomen, autour de la zone génitale ou dans les poumons.</p><h2>À retenir</h2><ul><li>Le syndrome néphrotique est un trouble qui apparaît en présence d’une protéinurie, d’une hypoalbuminémie et d’un œdème dans l’organisme.</li><li>La cause du syndrome néphrotique est encore inconnue.</li><li>Votre fournisseur de soins de santé vous demandera un échantillon d’urine et une analyse de sang pour diagnostiquer le syndrome néphrotique.</li><li>On utilise des stéroïdes pour traiter le syndrome néphrotique.</li><li>La plupart des enfants réagissent bien au traitement et obtiennent d’excellents résultats à long terme.</li></ul><h2>Signes et symptômes</h2><p>Initialement, lorsqu’un enfant est atteint du syndrome néphrotique, il peut être irritable et présenter un gonflement autour des yeux, de l’abdomen, des membres inférieurs et parfois des organes génitaux.</p><p>Vous pouvez également remarquer les changements suivants chez votre enfant :</p><ul><li>prise de poids due à la rétention d’eau</li><li>miction moins fréquente ou urine mousseuse</li><li>douleur ou gêne abdominale</li><li>diarrhée (selles molles) ou vomissements</li><li>sentiment général de malaise et de fatigue</li></ul><h2>Progression du syndrome néphrotique</h2><p>La plupart des syndromes néphrotiques chez les enfants sont idiopathiques, ce qui signifie que la cause du syndrome néphrotique est inconnue. Le syndrome néphrotique est plus fréquent chez les garçons que chez les filles, et apparaît souvent pour la première fois chez les enfants âgés de moins de 5 ans.</p><p>Les types les plus courants de syndrome néphrotique chez l’enfant sont le syndrome néphrotique à lésions glomérulaires minimes et la hyalinose segmentaire et focale (HSF).</p><p>Il arrive rarement que certains patients présentent un syndrome néphrotique au cours des premiers mois de la vie. Dans de tels cas, la cause est très probablement génétique; en d’autres termes, les glomérules ne se sont pas développés normalement avant la naissance.</p><h2>Diagnostic</h2><p>On pose le diagnostic en faisant des analyses d’urine pour détecter la protéinurie et des analyses de sang pour détecter l’hypoalbuminémie, en présence d’un œdème. La disparition des protéines dans l’urine après l’administration de prednisone permet de confirmer le diagnostic de syndrome néphrotique. Parfois, le médecin peut également recommander une <a href="/Article?contentid=35&language=English">biopsie rénale</a> pour faciliter le diagnostic et le traitement du syndrome néphrotique.</p><h2>Traitement du syndrome néphrotique</h2><p>L’objectif du traitement est d’empêcher les reins de laisser s’échapper des protéines dans l’urine. Le traitement initial du syndrome néphrotique est un traitement par la <a href="/Article?contentid=111&language=English">prednisone ou prednisolone</a>, administrée tous les jours pendant au moins six semaines, puis à doses progressivement réduites sur plusieurs mois. Les stéroïdes agissent de différentes manières sur le syndrome néphrotique, mais on ne connaît pas exactement leur mode d’action. Il est important de prendre la prednisone sans interruption selon les instructions, sans cesser brusquement la prise du médicament. Parfois, ce premier traitement suffit. Cependant, chez certains enfants, la maladie peut revenir et nécessiter un traitement supplémentaire.</p><p>En général, la prednisone est très efficace pour traiter le syndrome néphrotique. La plupart des enfants réagissent à la prednisone ; cependant, un petit nombre d’enfants n’y réagissent pas. Dans de tels cas, une <a href="/Article?contentid=35&language=English">biopsie rénale</a> peut être nécessaire. Certains enfants peuvent prendre d’autres médicaments qui inhibent le système immunitaire, comme le <a href="/Article?contentid=114&language=English">cyclophosphamide</a>, le <a href="/Article?contentid=245&language=English">tacrolimus</a>, le <a href="/Article?contentid=196&language=English">mycophénolate</a> ou le rituximab.</p><p>En cas d’œdème grave, votre enfant devra peut-être être admis à l’hôpital pour recevoir des protéines (albumine) par voie intraveineuse. Votre enfant peut également recevoir un diurétique pour l’aider à éliminer une partie du liquide supplémentaire qui s’est accumulé dans l’organisme. Il est très important pour un enfant atteint du syndrome néphrotique de suivre un régime alimentaire pauvre en sel pour éviter la rétention d’eau. La consommation de quantités supplémentaires de protéines dans l’alimentation n’aura aucun effet et n’est pas recommandée. Pendant la prise de la prednisone, il est également important de suivre un <a href="/Article?contentid=1201&language=English">régime alimentaire pauvre en sel et en calories</a>.</p><p>Lorsque votre enfant prend des stéroïdes, il court un risque d’infection plus élevé. Consultez immédiatement un médecin si votre enfant présente des signes de fièvre ou d’autres signes d’infection. Informez votre dentiste que votre enfant prend des stéroïdes et parlez à votre équipe de soins avant de le faire vacciner.</p><h2>Complications</h2><p>L’hyperlipidémie (taux élevé de cholestérol et de triglycérides dans le sang) est une conséquence courante du syndrome néphrotique. Si le taux d’albumine est faible en raison des fuites de protéines, l’équilibre des différentes graisses dans l’organisme est altéré, ce qui entraîne une élévation du taux de cholestérol. Ce phénomène est généralement temporaire et ne cause pas de dommages à long terme, car le taux de cholestérol se rééquilibre normalement avec le traitement.</p><p>Si le syndrome néphrotique n’est pas traité, des complications telles qu’une infection, une surcharge liquidienne (gonflement important entraînant une gêne), des lésions rénales et des caillots sanguins peuvent survenir.</p><h2>Quand appeler votre fournisseur de soins de santé</h2><ul><li>Si votre enfant a la varicelle ou est en contact direct avec une personne qui a la varicelle pendant qu’il prend de la prednisone.</li><li>Si les résultats de l’analyse d’urine sont à nouveau positifs pour les protéines.</li></ul><p>Emmenez votre enfant au service des urgences le plus proche s’il :</p><ul><li>est enflé</li><li>se sent mal et a de la fièvre</li><li>a un mal de tête persistant</li><li>a des vomissements ou des douleurs abdominales ou une diminution du débit urinaire</li></ul><h2>Sources de renseignements</h2><p>La Fondation canadienne du rein (<a href="https://rein.ca/">www.rein.ca</a>)</p><p>NephCure® Kidney International (<a href="https://nephcure.org/">www.nephcure.org</a>)</p><h2>Références</h2><p>Le syndrome néphrotique de l’enfant : Guide de gestion et de traitement du syndrome néphrotique de l’enfant à l’intention des parents. La Fondation canadienne du rein. Accédé à l’adresse <a href="https://www.kidney.ca/document.doc?id=330">https://www.kidney.ca/document.doc?id=330</a>.</p><p>Downie ML, Gallibois C, Parekh RS, Noone DG (2017). Nephrotic syndrome in infants and children: pathophysiology and management. <em>Paediatr Int Child Health, 37(4)</em>, 248-258.</p><p>Banh TM, Hussain-Shamsy N, Patel V, Vasilevska-Ristovska J, Borges K, Sibbald C, Lipszyc D, Brook, J, Geary D, Langlois V, Reddon M, Pearl R, Levin L, Piekut M, Licht C, Radhakrishnan S, Aitken-Menezes K, Harvey E, Hebert D, Piscione T, Parekh RS (2016). Ethnic differences in incidence and outcomes of childhood nephrotic syndrome. <em>Clin J Am Soc Nephrol, 11(10)</em>, 1760-1768.</p>

 

 

 

 

Nephrotic syndrome3846.00000000000Nephrotic syndromeNephrotic syndromeNEnglishNephrologyChild (0-12 years);Teen (13-18 years)KidneysKidneysConditions and diseases;SymptomsAdult (19+) CaregiversNA2020-01-23T05:00:00ZJosefina Brooke, RN, BScN, CNeph(C); Seetha Radhakrishnan, MDCM, FRCPC, MScCH; Ashley McNaughton, RN, BScN10.500000000000042.30000000000001531.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Nephrotic syndrome is one of the most common kidney diseases in children. It presents as a group of symptoms, which occur together in the body and include the presence of protein (albumin) in the urine and edema (swelling).</p><p>Nephrotic syndrome is a rare kidney condition that occurs in about five in 100,000 children worldwide. It is diagnosed when proteinuria (high levels of protein in the urine), hypoalbuminemia (low levels of albumin in the blood), and edema (swelling) are all present together in the body. Most children with nephrotic syndrome get better with treatment and experience no long-term kidney problems.</p><h2>What is nephrotic syndrome?</h2> <figure class="asset-c-80"> <span class="asset-image-title">Nephrotic syndrome</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/NephroticSyndrome_ProteinLeakage_Combined_EN.jpg" alt="The glomeruli in nephrotic syndrome allow protein to leak into the urine." /><figcaption class="asset-image-caption">The glomerulus (plural: glomeruli) of the kidney is a minuscule cluster of tiny blood vessels involved in filtering blood to form urine (pee). In nephrotic syndrome, the glomerulus allows protein to leak into the urine.</figcaption></figure> <h3>Proteinuria</h3><p>Proteinuria is when there are high levels of protein in the urine. Normally, there is little to no protein found in urine. In nephrotic syndrome, the glomeruli (the filters within the kidney) leak protein from the blood that flows through them into the urine they produce.</p><h3>Hypoalbuminemia</h3><p>Hypoalbuminemia is when low levels of protein (albumin) are found in the blood. When a large amount of protein leaks out into the urine, the body cannot make enough new protein to keep up. This results in hypoalbuminemia.</p><h3>Edema</h3><p>Edema happens in nephrotic syndrome because of low protein levels in the blood. Protein normally acts like a sponge to keep fluid in the blood vessels. With less protein in the blood, fluid leaks out of the blood vessels into other tissues. Edema is typically seen around the eyes, face and legs. Fluid can also build up in the abdomen, around the genital area or in the lungs.</p><h2>Key points</h2><ul><li>Nephrotic syndrome is a condition that occurs when proteinuria, hypoalbuminemia, and edema are present in the body.</li><li>The cause of nephrotic syndrome is still unknown.</li><li>Your health-care provider will ask for a urine sample and a blood test to diagnose nephrotic syndrome.</li><li>Steroid medications are used to treat nephrotic syndrome.</li><li>Most children respond well to treatment and will have excellent long-term outcomes.</li></ul><h2>Signs and symptoms</h2><p>When a child first presents with nephrotic syndrome, they may be irritable and have swelling around the eyes, abdomen, lower legs and sometimes the genitals.</p><p>You may also note the following changes in your child:</p><ul><li>Weight gain because of fluid retention</li><li>Less frequent urination (peeing) or foamy urine</li><li>Abdominal pain or discomfort</li><li>Diarrhea (loose stools) and/or vomiting</li><li>Feeling generally unwell and tired</li></ul><h2>Causes of nephrotic syndrome</h2><p>Most nephrotic syndrome in children is idiopathic, meaning that the cause of nephrotic syndrome is unknown. Nephrotic syndrome is more common in boys than girls, and often appears for the first time in children under five years of age.</p><p>The most common types of nephrotic syndrome in children are minimal change disease and focal segmental glomerulosclerosis (FSGS).</p><p>Rarely, some patients have nephrotic syndrome in the first few months of life. In these cases, the cause is most likely genetic, meaning that the glomeruli did not develop normally before birth.</p><h2>Course of nephrotic syndrome</h2><p>For childhood nephrotic syndrome, most patients respond well to treatment with a steroid medication called <a href="/Article?contentid=111&language=English">prednisone or prednisilone</a>. About 80% of children will improve with steroids. Even with successful initial treatment, some children with nephrotic syndrome can have relapses. Treatment plans for children with relapses are customized based on whether the child has frequent or infrequent relapses. Prognosis is excellent—the majority of children, especially those with minimal change disease, will outgrow nephrotic syndrome and become adults with normal functioning kidneys.</p><h2>Diagnosis</h2><p>Diagnosis is made by testing the urine for proteinuria, and the blood for hypoalbuminemia, in the presence of edema. The disappearance of protein in the urine after the use of prednisone helps to confirm the diagnosis of nephrotic syndrome. Sometimes, the doctor may also recommend a <a href="/Article?contentid=35&language=English">kidney biopsy</a> to help with the diagnosis and treatment of nephrotic sydrome.</p><h2>Treatment of nephrotic syndrome</h2><p>The goal of treatment is to stop the kidneys from leaking protein into the urine. The initial treatment of nephrotic syndrome is with <a href="/Article?contentid=111&language=English">prednisone or prednisilone</a>, which is taken every day for at least six weeks and then slowly decreased over several months. Steroids work in many different ways for nephrotic syndrome, but the exact way they work is not known. It is important to continuously take prednisone as instructed without stopping suddenly. Sometimes, this first course of treatment is all that is needed. However, for some children, the disease can return, which requires further treatment.</p><p>Prednisone usually works very well to treat nephrotic syndrome. Most children respond to prednisone; however, a small number of children do not. In these cases, a <a href="/Article?contentid=35&language=English">kidney biopsy</a> may be required. Some children may need to take other medications that suppress the immune system, such as <a href="/Article?contentid=114&language=English">cyclophosphamide</a>, <a href="/Article?contentid=245&language=English">tacrolimus</a>, <a href="/Article?contentid=196&language=English">mycophenolate</a> or rituximab.</p><p>If there is severe edema, your child may need to be admitted to the hospital to receive protein (albumin) intravenously. Your child may also be given a diuretic (“water pill”) to help remove some of the extra fluid that has accumulated in the body. It is very important for a child with nephrotic syndrome to eat a low-salt diet to prevent fluid retention. Consuming more protein in the diet will have no effect and is not recommended. While on prednisone, it is also important to eat a <a href="/Article?contentid=1201&language=English">low-salt and low calorie diet</a>.</p><p>While on steroid medication, your child is at higher risk of infection. Seek immediate medical attention if your child shows signs of fever or other signs of infection. Let your dentist know that your child is on steroids, and speak to your health-care team before giving any vaccinations.</p><h2>Complications</h2><p>Hyperlipidemia (high levels of blood cholesterol and triglycerides) is a common consequence of nephrotic syndrome. If albumin levels are low due to leakage, the balance of various fats in the body is altered, which leads to high levels of cholesterol. This is usually temporary and does not cause long-term harm, as cholesterol levels normally re-balance with treatment.</p><p>If nephrotic syndrome is left untreated, complications such as infection, fluid overload (significant swelling causing discomfort), kidney injury and blood clots can occur.</p><h2>Your role as a caregiver</h2> <figure><span class="asset-image-title">Dipstick bottle</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/NephroticSyndrome_Dipstick.jpg" alt="A dipstick bottle with a dipstick showing negative for protein" /></figure> <p>It is important for you to monitor your child’s urine for protein because it is the first sign of a relapse. Your health-care provider will teach you how to check your child’s urine with a dipstick. You will need to check the first sample of urine every morning and report back to your health-care team if the dipstick tests positive for protein (anything greater than ‘trace’ amounts [greater than 0.3 g/L]). Your health-care provider may recommend keeping a bathroom scale at home to look for sudden changes in weight.</p><h3>How to test urine for protein with dipsticks:</h3><ol><li>Collect first morning urine into a clean container.</li><li>Take one strip out of bottle, and close bottle tightly.</li><li>Dip the strip into the urine quickly. Be sure the square on the tip is wet with urine.</li><li>Place the strip on a flat surface and wait 60 seconds.</li><li>Compare the colour of the stick to the colours on the bottle.</li><li>Record the value: the packaging should show you which range(s) indicate “normal.”</li></ol><p>If the dipstick results show as above the “normal” range (0.3 g/L or higher), contact your health-care provider.</p><p> <strong>Note:</strong> Always check the expiry date of the dipstick bottle. Be sure to test the urine while it is fresh (within one hour). Ensure that the dipsticks are stored in a cool, dry place and that the bottle remains tightly sealed. <strong>Do not store dipsticks in the kitchen or bathroom.</strong></p><h2>Prevention of complications</h2><ul><li>Always give medication as directed by your health-care provider.</li><li>It is important to regularly monitor your child’s urine.</li><li>Adhering to a low-salt diet during a relapse also helps control symptoms.</li></ul><h2>When to call your health-care provider</h2><ul><li>If your child has chicken pox, or has direct contact with someone who has chicken pox, while on prednisone.</li><li>If urine becomes positive for protein again.</li></ul><p>Take your child to the nearest emergency department if your child:</p><ul><li>is swollen</li><li>is unwell with a fever</li><li>has a persistent headache</li><li>has vomiting or abdominal pain and/or decreased urine output</li></ul><h2>Long-term outcomes/future expectations</h2><p>Most children respond well to treatment and have a good outlook. Nephrotic syndrome rarely causes kidney failure and children are likely to grow out of it. It is not uncommon for children to have at least one relapse. If your child has a relapse, they will receive repeated treatment with prednisone or other medications. Sometimes, continuous low-dose steroids every second day and/or an additional medicine may be needed to stop relapses that occur too often.</p><h2>Resources</h2><p>The Kidney Foundation of Canada (<a href="https://www.kidney.ca/">www.kidney.ca</a>)</p><p>NephCure® Kidney International (<a href="https://nephcure.org/">www.nephcure.org</a>)</p><h2>References</h2><p>Childhood Nephrotic Syndrome: A Guide for the Parents on the Management and Treatment of Childhood Nephrotic Syndrome. <em>The Kidney Foundation of Cananda</em>. Retrieved from <a href="https://www.kidney.ca/document.doc?id=330">https://www.kidney.ca/document.doc?id=330</a>.</p><p>Downie ML, Gallibois C, Parekh RS, Noone DG (2017). Nephrotic syndrome in infants and children: pathophysiology and management. <em>Paediatr Int Child Health, 37(4)</em>, 248-258.</p><p>Banh TM, Hussain-Shamsy N, Patel V, Vasilevska-Ristovska J, Borges K, Sibbald C, Lipszyc D, Brook, J, Geary D, Langlois V, Reddon M, Pearl R, Levin L, Piekut M, Licht C, Radhakrishnan S, Aitken-Menezes K, Harvey E, Hebert D, Piscione T, Parekh RS (2016). Ethnic differences in incidence and outcomes of childhood nephrotic syndrome. <em>Clin J Am Soc Nephrol, 11(10)</em>, 1760-1768.</p>Nephrotic syndromeFalse