Nephrotic syndrome is a kidney disorder that affects both children and adults. It is characterised by a range of symptoms that can significantly impact a person's quality of life. Understanding nephrotic syndrome, its causes, potential complications, and whether it can be cured is crucial for patients and their families.
Nephrotic Syndrome Definition and Overview:
Nephrotic syndrome is a condition that occurs when the kidneys' filtering units, called glomeruli, become damaged. This damage allows large amounts of protein to leak from the blood into the urine.
The symptoms of nephrotic syndrome include severe proteinuria (high levels of protein in the urine), hypoalbuminemia (low levels of albumin in the blood), hyperlipidemia (high levels of fats or lipids in the blood), and edema (swelling, particularly in the legs, ankles, and around the eyes).
The underlying causes of nephrotic syndrome can vary, with primary causes directly affecting the kidneys (such as minimal change disease, focal segmental glomerulosclerosis, or membranous nephropathy) and secondary causes related to systemic diseases (such as diabetes, lupus, or infections).
Nephrotic Syndrome vs. Nephritic Syndrome: Key Differences
While nephrotic syndrome and nephritic syndrome both involve the kidneys, they are distinct conditions with different characteristics:
Nephrotic Syndrome: Primarily characterised by heavy proteinuria, hypoalbuminemia, hyperlipidemia, and edema. The condition results from damage to the glomeruli that affects their ability to retain protein in the bloodstream.
Nephritic Syndrome: Involves inflammation of the glomeruli and is characterised by hematuria (blood in the urine), hypertension (high blood pressure), oliguria (reduced urine output), and mild to moderate proteinuria. Nephritic syndrome is often caused by infections or autoimmune diseases.
Understanding the differences between these two syndromes is essential for accurate diagnosis and treatment.
Can Nephrotic Syndrome Be Cured in Children and Adults?
The possibility of curing nephrotic syndrome depends on several factors, including the underlying cause, the patient's age, and the severity of the condition.
In Children: Nephrotic syndrome in children is often caused by minimal change disease, which has a favourable prognosis. The condition typically responds well to corticosteroids, and many children achieve complete remission. However, some children may experience relapses, and long-term management may be necessary. In cases where the condition is secondary to another disease, the prognosis depends on the successful treatment of the underlying cause.
In Adults: Nephrotic syndrome in adults is more likely to be caused by conditions like focal segmental glomerulosclerosis (FSGS) or membranous nephropathy. These conditions can be more challenging to treat, and the response to therapy may vary. While some adults achieve remission, others may require long-term treatment to manage symptoms and prevent complications.
In both children and adults, the concept of "cure" may be relative. While some patients may achieve complete remission, others may experience chronic symptoms or relapses.
Can Nephrotic Syndrome Lead to Kidney Failure?
Nephrotic syndrome can potentially lead to kidney failure, especially if it is not managed effectively. The risk of kidney failure depends on the underlying cause and the severity of the condition:
Progression of Disease: Chronic glomerular diseases, such as FSGS or membranous nephropathy, can lead to progressive kidney damage. Over time, this can result in chronic kidney disease (CKD) and eventually kidney failure, requiring dialysis or a kidney transplant.
Complications: Persistent proteinuria and associated conditions like hypertension can accelerate kidney damage. Regular monitoring and aggressive management of symptoms are crucial to prevent progression to kidney failure.
Can Nephrotic Syndrome Come Back?
Yes, nephrotic syndrome can recur, particularly in cases where the underlying cause is not completely resolved or where the patient’s experiences worsen. Recurrences can occur in both children and adults, and the frequency and severity of relapses can vary:
Children: Relapses are common in children with minimal change disease, even after achieving initial remission. However, most children respond well to repeated courses of corticosteroids.
Adults: Adults with nephrotic syndrome may experience relapses, particularly if the underlying condition is not well-controlled. In some cases, long-term immunosuppressive therapy may be required to prevent recurrences.
Can Nephrotic Syndrome Be Reversed?
Reversing nephrotic syndrome involves achieving remission, where symptoms are reduced or eliminated, and normal kidney function is restored. The potential for reversal depends on:
Early Diagnosis and Treatment: Prompt and effective treatment can improve the chances of reversing nephrotic syndrome, particularly in cases caused by minimal change in disease in children.
Underlying Cause: If the underlying cause is treatable or reversible (e.g., an infection or drug-induced nephrotic syndrome), the condition may be reversed with appropriate therapy.
Chronicity: Chronic glomerular diseases may be less likely to reverse completely, but symptom management and slowing disease progression are achievable goals.
Can Nephrotic Syndrome Cause Death?
While nephrotic syndrome itself is not typically fatal, it can lead to serious complications that may increase the risk of death if not properly managed:
Infections: Patients with nephrotic syndrome are at increased risk of infections due to loss of immunoglobulins in the urine. Severe infections, particularly in immunocompromised patients, can be life-threatening.
Thromboembolism: Nephrotic syndrome can increase the risk of blood clots, which can lead to life-threatening conditions like pulmonary embolism or deep vein thrombosis.
Kidney Failure: Progressive kidney damage can lead to end-stage renal disease (ESRD), which requires dialysis or a kidney transplant. Without appropriate treatment, ESRD can be fatal.
Proper management, regular monitoring, and prompt treatment of complications are essential to reduce the risk of mortality associated with nephrotic syndrome.
Can a Nephrotic Syndrome Patient Get Pregnant?
Women with nephrotic syndrome can become pregnant, but the condition can complicate pregnancy. It is important for patients to work closely with their healthcare providers to manage their condition before and during pregnancy:
Pre-Pregnancy Counselling: Women with nephrotic syndrome should undergo pre-pregnancy counselling to assess kidney function, control symptoms, and discuss potential risks.
Medication Management: Certain medications used to treat nephrotic syndrome may need to be adjusted or discontinued during pregnancy to avoid harm to the foetus.
Monitoring: Pregnant women with nephrotic syndrome require close monitoring for complications, including hypertension, preeclampsia, and worsening kidney function.
Can Nephrotic Syndrome Affect Pregnancy?
Nephrotic syndrome affects pregnancy. However, it can increase the following risk of complications for both the mother and the baby:
Preeclampsia: Women with nephrotic syndrome are at an increased risk of developing preeclampsia, a condition characterized by high blood pressure and damage to organs, particularly the kidneys and liver.
Preterm Birth: The risk of preterm birth is higher in women with nephrotic syndrome due to complications such as preeclampsia or worsening kidney function.
Foetal Growth Restriction: Reduced blood flow to the placenta can result in fetal growth restriction, where the baby is smaller than expected for the gestational age.
Careful management and close monitoring by a multidisciplinary team, including a nephrologist and obstetrician, are essential to optimise pregnancy outcomes.
Conclusion:
Nephrotic syndrome is a complex kidney disorder that affects both children and adults, with significant implications for health and quality of life. While the condition can be managed and sometimes reversed, particularly in cases with early diagnosis and treatment, it requires ongoing care and monitoring.
Understanding the differences between nephrotic and nephritic syndrome, the potential complications such as kidney failure, anaemia, and hyperkalemia (high potassium in blood), as well as the impact on pregnancy, is crucial for patients and their families. Though nephrotic syndrome can recur and pose serious health risks, proactive management and a multidisciplinary approach can help patients lead healthy, fulfilling lives.
Dr. Praveen Malavade is an expert nephrologist at Shivamogga who treats patients with nephrotic syndrome. You can visit us at Shivamogga or any other branch preferable to you.
References:
PubMed 1- https://pubmed.ncbi.nlm.nih.gov/30226702/
PubMed 2- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10924861/
PubMed 3 - https://pubmed.ncbi.nlm.nih.gov/28233609/
PubMed 4 - https://pubmed.ncbi.nlm.nih.gov/25600490/
