What is Nephrotic Syndrome?
It is a kidney disorder that causes the body to excrete too much protein, mostly albumin, which helps keep fluid in the blood, into the urine. It is not normal to find protein in the urine. Protein lost in the urine leads to lowering of its blood levels. Usually, proteins in the blood act like a sponge in keeping the fluid within the blood vessels.
What are the signs to look for in children?
Children mostly develop swelling (Oedema), especially around the eyes, in the face, feet, ankles, and abdomen (tummy). This is because of lowering of the blood protein levels, which results in leakage of the fluid out of the blood vessels in the body tissue.
When is a child diagnosed with Nephrotic Syndrome?
The simplest way is to test the urine is with an Albustix test for the presence of protein. Children with 2+ or more protein in the urine should be evaluated for Nephrotic Syndrome.
How do you know that your child may have a relapse of Nephrotic Syndrome?
When your child passes frothy urine or there is generalised swelling of the face, eyelids or feet. Moreover, when urine tests of your child show protein loss.
How can Nephrotic Syndrome-affected children be treated?
The initial treatment of childhood Nephrotic Syndrome is a steroid called Prednisolone, for a period of 12 weeks, along with appropriate supportive medications and dietary modifications. It also helps control protein leak. Typically, more than 90% of the children with Nephrotic Syndrome respond to this treatment.
What to do in case of relapse?
The majority of the children with the Nephrotic Syndrome will have 1-2 relapses a year, when the symptoms come back after treatment, for the next few years. However, 40% may relapse frequently, hence, they will need long-term treatment. In such cases, other medications may be used besides steroids. Around 5-10% of the children do not show any response to initial steroid therapy and continue to have a heavy protein loss in their urine. This group usually needs a kidney biopsy for further evaluation.
What should your child do?
A low sodium (salt) diet is recommended when your child is swollen. In case of relapse, please try to reduce your child’s intake of processed foods which come in the form of crisps, tinned or packets and refrain from adding salt to the food once it is cooked. Your child should eat fiber-rich foods like whole-meal bread, whole-wheat breakfast cereals, fruit and vegetables. Also, your child should not take too much of sweets.
How to assist children with Nephrotic Syndrome?
You will be given a Nephrotic Diary to chart for child’s daily urine results. Every morning you should dip an Albustix into your child’s first morning urine to compare the colour of the Albustix with the colour chart on the container. You are advised to bring the diary during each clinic visit.
Source: Shaw-NKF Children’s Kidney Centre. The Children’s Medical Institute, National University Hospital, Singapore.
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