Nephrotic Syndrome

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1- Introduction

2- Pathophysiology

3- Symptoms

4- Treatment


Nephrotic syndrome is a kidney disorder characterized by a group of symptoms that indicate damage to the kidneys’ filtering units, known as glomeruli. These symptoms include excessive protein in the urine (proteinuria), low levels of protein in the blood, swelling (edema), and high cholesterol levels. It can be caused by various underlying conditions affecting the kidneys, and treatment aims to manage symptoms, reduce protein loss, and address the underlying cause to prevent complications.


ephrotic syndrome is primarily characterized by dysfunction in the glomeruli of the kidneys, which are responsible for filtering blood and removing waste products while retaining essential substances such as proteins. The pathophysiology of nephrotic syndrome involves damage or abnormalities in the glomerular filtration barrier, a complex structure consisting of endothelial cells, basement membrane, and podocytes (specialized cells that wrap around capillaries in the glomerulus).

In nephrotic syndrome, this filtration barrier becomes compromised, leading to increased permeability to proteins, particularly albumin. As a result, large amounts of protein, mainly albumin, leak from the blood into the urine, a condition known as proteinuria. This loss of protein from the bloodstream lowers the levels of protein in the blood, leading to hypoalbuminemia. The reduced oncotic pressure in the blood vessels due to low albumin levels contributes to the accumulation of fluid in the body’s tissues, causing edema, especially in the legs, ankles, and around the eyes.

The underlying causes of nephrotic syndrome can vary and may include primary kidney diseases such as minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or secondary causes such as diabetes mellitus, lupus nephritis, infections, or certain medications. In addition to proteinuria and hypoalbuminemia, individuals with nephrotic syndrome often exhibit hyperlipidemia (elevated levels of cholesterol and triglycerides) due to increased liver synthesis of lipoproteins in response to low albumin levels.

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  • Proteinuria: Excessive protein excretion in the urine, which may cause frothy or foamy urine.

  • Hypoalbuminemia: Low levels of albumin in the blood, leading to reduced oncotic pressure and fluid accumulation in tissues (edema).

  • Edema: Swelling, commonly noticed in the face (around the eyes), hands, feet, and abdomen. Edema may worsen throughout the day and improve with rest.

  • Hyperlipidemia: Elevated levels of cholesterol and triglycerides in the blood, which can contribute to atherosclerosis and cardiovascular disease risk.

  • Fatigue and Weakness: Due to loss of protein and subsequent nutritional deficiencies.

  • Weight Gain: Often due to fluid retention and edema.

  • Foamy Urine: Resulting from excess protein in the urine.


1. Medications:

  • Corticosteroids: Such as prednisone, are commonly used for primary nephrotic syndromes like minimal change disease and focal segmental glomerulosclerosis (FSGS) to reduce inflammation and proteinuria.

  • Immunosuppressive Agents: In cases where corticosteroids alone are ineffective or not tolerated, medications like cyclophosphamide, tacrolimus, or mycophenolate mofetil may be used to suppress the immune system and reduce proteinuria.

  • Angiotensin-Converting Enzyme (ACE) Inhibitors or Angiotensin II Receptor Blockers (ARBs): These medications help lower blood pressure and reduce proteinuria by dilating blood vessels around the kidneys.

  • Diuretics: Such as furosemide or spironolactone, to help reduce edema and fluid retention.

  • Statins: Medications to lower cholesterol levels and manage hyperlipidemia associated with nephrotic syndrome.

2. Dietary and Lifestyle Modifications:

  • Low-Sodium Diet: To help manage edema and fluid retention.

  • Moderate Protein Intake: To reduce the workload on the kidneys while maintaining adequate nutrition.

  • Weight Management: Achieving and maintaining a healthy weight can reduce strain on the kidneys and improve overall health outcomes.

3. Supportive Care:

  • Edema Management: Elevating legs, wearing compression stockings, and limiting salt intake to reduce fluid retention.

  • Monitoring and Follow-Up: Regular check-ups with a healthcare provider to monitor kidney function, proteinuria levels, blood pressure, and cholesterol levels.

4. Treatment of Underlying Causes:

  • Specific Treatment: Depending on the underlying cause of nephrotic syndrome, such as treating infections, managing diabetes, or addressing autoimmune conditions.

5. Complications Management:

  • Blood Clot Prevention: Especially in cases of severe proteinuria, which increases the risk of blood clots (thromboembolism).

  • Monitoring for Infections: Due to the increased susceptibility associated with immunosuppressive therapy.

6. Referral to a Nephrologist:

  • Specialized Care: For comprehensive management and treatment planning, especially in cases of resistant or complex nephrotic syndromes.
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