What Is Childhood Nephrotic Syndrome - Wirral University Teaching ...
What Is Childhood Nephrotic Syndrome - Wirral University Teaching ... What Is Childhood Nephrotic Syndrome - Wirral University Teaching ...
What Is Childhood Nephrotic Syndrome The kidneys are a pair of organs in the lower back. Their main function is to clean the blood, by filtering out excess water, salt and waste products. This is how urine is made. Blood contains special proteins, which help keep water inside the blood vessels. Healthy kidneys will not filter out these proteins. In Nephrotic syndrome, the filter system is damaged, allowing proteins to leak into urine. This means there is less protein in the blood vessels, so water passes into the body tissues causing swelling (oedema). What Causes Nephrotic Syndrome At present, the cause is not known, but research is being done. It affects approximately 1 in 50,000 children per year. It is more common in boys than girls. It tends to occur in children aged 2-6 years. It is more common in families with a history of allergies. Symptoms of Childhood Nephrotic syndrome: ∗ ∗ ∗ ∗ ∗ Swelling – especially around the eyes, legs, abdomen Passing urine less often or smaller amounts Weight gain Tiredness Abdominal pain To diagnose nephrotic syndrome, urine will be tested for protein levels (which would be high). Blood tests may be done to check how well the kidneys are working and to measure blood protein levels (which would be low). Rarely a kidney biopsy may be needed – this is a special test where a sample of tissue from your child’s kidney is looked at under the microscope. How is Childhood Nephrotic Syndrome Treated ∗ ∗ ∗ ∗ Steroids – Prednisolone (steroid medication) helps reduce protein leakage from the kidneys. For most children, within a few weeks, protein will disappear from the urine and swelling will resolve – this is called remission. Your child’s doctor will gradually reduce and then stop the prednisolone after this. Diet – Special dietary precautions are not required. Children should eat a healthy diet. They should avoid large amounts of salt, bacon, sausages, tinned and packet savoury foods. Sometimes doctors may advise you to limit the amount of fluids your child drinks. Cutting down on salt and salty foods at this time will help stop your child feeling too thirsty. Urine Testing – Parents may be asked to regularly test their child’s urine for protein. This helps us to monitor your child’s response to treatment. If they are in remission (protein-free), regular testing will help us to detect a relapse (recurrence of protein in the urine) early. You should keep a diary of the urine test results and take this to clinic. Antibiotics – Children can be more prone to infections, so they may be given a course of antibiotics as a preventative measure, until the swelling has resolved. ∗ Other Medications – Water tablets (diuretics) may be used to help reduce swelling. If your child develops high blood pressure, tablets may be given to help lower this. If prednisolone does not work or your child has a relapse, other drugs may be used. The Future . . . Most children will recover from nephrotic syndrome, though may have relapses requiring steroid treatment. Relapses will become less
<strong>What</strong> <strong>Is</strong> <strong>Childhood</strong> <strong>Nephrotic</strong> <strong>Syndrome</strong><br />
The kidneys are a pair of organs in the lower back. Their main<br />
function is to clean the blood, by filtering out excess water, salt and<br />
waste products. This is how urine is made.<br />
Blood contains special proteins, which help keep water inside the<br />
blood vessels. Healthy kidneys will not filter out these proteins.<br />
In <strong>Nephrotic</strong> syndrome, the filter system is damaged, allowing proteins<br />
to leak into urine. This means there is less protein in the blood vessels,<br />
so water passes into the body tissues causing swelling (oedema).<br />
<strong>What</strong> Causes <strong>Nephrotic</strong> <strong>Syndrome</strong><br />
At present, the cause is not known, but research is being done. It<br />
affects approximately 1 in 50,000 children per year. It is more common<br />
in boys than girls. It tends to occur in children aged 2-6 years. It is<br />
more common in families with a history of allergies.<br />
Symptoms of <strong>Childhood</strong> <strong>Nephrotic</strong> syndrome:<br />
∗<br />
∗<br />
∗<br />
∗<br />
∗<br />
Swelling – especially around the eyes, legs, abdomen<br />
Passing urine less often or smaller amounts<br />
Weight gain<br />
Tiredness<br />
Abdominal pain<br />
To diagnose nephrotic syndrome, urine will be tested for protein<br />
levels (which would be high). Blood tests may be done to check how<br />
well the kidneys are working and to measure blood protein levels<br />
(which would be low). Rarely a kidney biopsy may be needed – this is<br />
a special test where a sample of tissue from your child’s kidney is<br />
looked at under the microscope.<br />
How is <strong>Childhood</strong> <strong>Nephrotic</strong> <strong>Syndrome</strong> Treated<br />
∗<br />
∗<br />
∗<br />
∗<br />
Steroids – Prednisolone (steroid medication) helps reduce protein<br />
leakage from the kidneys. For most children, within a few weeks,<br />
protein will disappear from the urine and swelling will resolve – this<br />
is called remission. Your child’s doctor will gradually reduce and<br />
then stop the prednisolone after this.<br />
Diet – Special dietary precautions are not required. Children<br />
should eat a healthy diet. They should avoid large amounts of salt,<br />
bacon, sausages, tinned and packet savoury foods. Sometimes<br />
doctors may advise you to limit the amount of fluids your child<br />
drinks.<br />
Cutting down on salt and salty foods at this time will help stop your<br />
child feeling too thirsty.<br />
Urine Testing – Parents may be asked to regularly test their<br />
child’s urine for protein. This helps us to monitor your child’s<br />
response to treatment. If they are in remission (protein-free),<br />
regular testing will help us to detect a relapse (recurrence of<br />
protein in the urine) early. You should keep a diary of the urine test<br />
results and take this to clinic.<br />
Antibiotics – Children can be more prone to infections, so they<br />
may be given a course of antibiotics as a preventative measure,<br />
until the swelling has resolved.<br />
∗ Other Medications – Water tablets (diuretics) may be used to help<br />
reduce swelling. If your child develops high blood pressure, tablets<br />
may be given to help lower this. If prednisolone does not work or<br />
your child has a relapse, other drugs may be used.<br />
The Future . . .<br />
Most children will recover from nephrotic syndrome, though may have<br />
relapses requiring steroid treatment. Relapses will become less
frequent as your child becomes older. Children with nephrotic<br />
syndrome that responds to steroids, will NOT develop kidney failure.<br />
Seek medical advice if your child . . .<br />
. . . has protein in the urine (+++ or more) for 3 days in a row<br />
. . . has any of the following symptoms:<br />
• Puffy<br />
• Unwell<br />
• Fever<br />
• Severe abdominal pain<br />
• Severe pain / swelling / colour change in an arm or leg<br />
. . . is due for immunisations<br />
. . . comes into close contact with chicken pox or measles<br />
For further information the following websites may be of help:-<br />
www.yourchildshealth.nhs.uk<br />
www.kidney.org.uk/kids<br />
<strong>Nephrotic</strong> <strong>Syndrome</strong><br />
References<br />
Dr Young (WiSCH Protocol Group) Management of steroid-responsive nephrotic syndrome<br />
(WiSCH Directorate Protocols) 2005<br />
Holt R, Webb N. Management of nephrotic syndrome in childhood. Current Paediatrics<br />
2002;12:551-560<br />
Patient Information Leaflet<br />
Giving up smoking<br />
Giving up smoking anytime can be beneficial. Help to give up smoking is available<br />
from <strong>Wirral</strong> SUPPORT by telephoning the FagEnds freephone helpline on 0800 195<br />
2131. In hospital, support for smokers, including nicotine replacement therapy, is<br />
available.<br />
Author: Dr Geetha Segarajasingam<br />
Publication Date: May 2007<br />
Review Date: May 2009<br />
<strong>Wirral</strong> Hospital NHS Trust<br />
Arrowe Park Hospital, Arrowe Park Road,<br />
Upton, <strong>Wirral</strong>, Merseyside, CH49 5PE<br />
<strong>Wirral</strong> Hospital operates a ‘non smoking’ policy<br />
and is now totally smoke free on all sites.<br />
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