What Is Nephrotic Syndrome?
Overview
Nephrotic syndrome happens when damage to your kidneys causes them to release too much protein into your urine. Other characteristics of this disease include:
- swelling in your legs, ankles, feet, and face
- high cholesterol levels
- high triglyceride levels
Nephrotic syndrome isn’t itself a disease. Diseases that damage blood vessels in your kidneys cause this condition.
Nephrotic syndrome happens when damage to your kidneys causes them to release too much protein into your urine. Other characteristics of this disease include:
- swelling in your legs, ankles, feet, and face
- high cholesterol levels
- high triglyceride levels
Nephrotic syndrome isn’t itself a disease. Diseases that damage blood vessels in your kidneys cause this condition.
Symptoms of nephrotic syndrome
Symptoms of nephrotic syndrome include:
- swelling (edema) in your ankles and feet, and around your eyes
- foamy urine
- weight gain from fluid buildup in your body
- fatigue
- appetite loss
- high cholesterol and triglyceride levels
Symptoms of nephrotic syndrome include:
- swelling (edema) in your ankles and feet, and around your eyes
- foamy urine
- weight gain from fluid buildup in your body
- fatigue
- appetite loss
- high cholesterol and triglyceride levels
Causes of nephrotic syndrome
Your kidneys are filled with tiny blood vessels, called glomeruli. As your blood moves through these vessels, extra water and waste products are filtered into the urine. Protein and other substances that your body needs stay in your bloodstream.
Nephrotic syndrome happens when the glomeruli are damaged and can’t properly filter your blood. Damage to these blood vessels allows protein to leak into your urine.
Albumin is one of the proteins lost in the urine. Albumin helps pull extra fluid from your body into your kidneys. This fluid is then removed in the urine. Without albumin, your body holds onto the extra fluid. This causes swelling (edema) in your legs, feet, ankles, and face.
Some conditions that cause nephrotic syndrome only affect the kidneys. These are called primary causes of nephrotic syndrome. These conditions include:
- Focal segmental glomerulosclerosis. A condition in which the glomeruli become scarred from disease, a genetic defect, or an unknown cause.
- Membranous nephropathy. In this disease, the membranes in the glomeruli thicken. The cause of the thickening isn’t known, but it may occur along with lupus, hepatitis B, malaria, or cancer.
- Minimal change disease. In this condition, the kidney tissue looks normal under a microscope, but for some unknown reason, it doesn’t filter properly.
- Renal vein thrombosis. In this disorder, a blood clot blocks a vein that drains blood out of the kidney.
Other diseases that cause nephrotic syndrome affect the whole body. These are called secondary causes of nephrotic syndrome. These conditions include:
- Diabetes. In this disease, uncontrolled blood sugar can damage blood vessels all over your body, including in your kidneys.
- Lupus. Lupus is an autoimmune disease that causes inflammation in the joints, kidneys, and other organs.
- Amyloidosis. This rare disease is caused by a buildup of the protein amyloid in your organs. Amyloid can build up in, and damage your kidneys.
Some medications, including antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs), have also been linked to nephrotic syndrome.
Your kidneys are filled with tiny blood vessels, called glomeruli. As your blood moves through these vessels, extra water and waste products are filtered into the urine. Protein and other substances that your body needs stay in your bloodstream.
Nephrotic syndrome happens when the glomeruli are damaged and can’t properly filter your blood. Damage to these blood vessels allows protein to leak into your urine.
Albumin is one of the proteins lost in the urine. Albumin helps pull extra fluid from your body into your kidneys. This fluid is then removed in the urine. Without albumin, your body holds onto the extra fluid. This causes swelling (edema) in your legs, feet, ankles, and face.
Some conditions that cause nephrotic syndrome only affect the kidneys. These are called primary causes of nephrotic syndrome. These conditions include:
- Focal segmental glomerulosclerosis. A condition in which the glomeruli become scarred from disease, a genetic defect, or an unknown cause.
- Membranous nephropathy. In this disease, the membranes in the glomeruli thicken. The cause of the thickening isn’t known, but it may occur along with lupus, hepatitis B, malaria, or cancer.
- Minimal change disease. In this condition, the kidney tissue looks normal under a microscope, but for some unknown reason, it doesn’t filter properly.
- Renal vein thrombosis. In this disorder, a blood clot blocks a vein that drains blood out of the kidney.
Other diseases that cause nephrotic syndrome affect the whole body. These are called secondary causes of nephrotic syndrome. These conditions include:
- Diabetes. In this disease, uncontrolled blood sugar can damage blood vessels all over your body, including in your kidneys.
- Lupus. Lupus is an autoimmune disease that causes inflammation in the joints, kidneys, and other organs.
- Amyloidosis. This rare disease is caused by a buildup of the protein amyloid in your organs. Amyloid can build up in, and damage your kidneys.
Some medications, including antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs), have also been linked to nephrotic syndrome.
How is it treated?
Your doctor can treat the condition that caused nephrotic syndrome, as well as the symptoms of this syndrome.
Blood pressure medications lower blood pressure, and reduce the amount of protein lost in the urine. These medications include:
- angiotensin-converting enzyme inhibitors — benazepril (Lotensin), captopril (Capoten), and enalapril (Vasotec)
- angiotensin II receptor blockers — losartan potassium (Cozaar) and valsartan (Diovan)
Diuretics cause your kidneys to release extra fluid, which brings down swelling. These medications include:
- furosemide (Lasix)
- spironolactone (Aldactone)
Statins lower cholesterol levels. These medications include:
- atorvastatin calcium (Lipitor)
- fluvastatin sodium (Lescol)
- lovastatin (Altoprev, Mevacor)
- pravastatin sodium (Pravachol)
- rosuvastatin calcium (Crestor)
- simvastatin (Zocor)
Because of the increased risk for infection, your doctor may recommend that you get a pneumococcal vaccine and yearly flu shot.
Your doctor can treat the condition that caused nephrotic syndrome, as well as the symptoms of this syndrome.
Blood pressure medications lower blood pressure, and reduce the amount of protein lost in the urine. These medications include:
- angiotensin-converting enzyme inhibitors — benazepril (Lotensin), captopril (Capoten), and enalapril (Vasotec)
- angiotensin II receptor blockers — losartan potassium (Cozaar) and valsartan (Diovan)
Diuretics cause your kidneys to release extra fluid, which brings down swelling. These medications include:
- furosemide (Lasix)
- spironolactone (Aldactone)
Statins lower cholesterol levels. These medications include:
- atorvastatin calcium (Lipitor)
- fluvastatin sodium (Lescol)
- lovastatin (Altoprev, Mevacor)
- pravastatin sodium (Pravachol)
- rosuvastatin calcium (Crestor)
- simvastatin (Zocor)
Because of the increased risk for infection, your doctor may recommend that you get a pneumococcal vaccine and yearly flu shot.
Diet
Diet is also important for controlling nephrotic syndrome. Limit the amount of salt you eat to prevent swelling and to control your blood pressure. Your doctor may also suggest that you drink less fluid to reduce swelling.
Nephrotic syndrome can increase your cholesterol and triglyceride levels, so try to eat a diet that’s low in saturated fat and cholesterol.
Although this condition causes you to lose protein in your urine, eating extra protein is not recommended. A high-protein diet can make nephrotic syndrome worse.
Diet is also important for controlling nephrotic syndrome. Limit the amount of salt you eat to prevent swelling and to control your blood pressure. Your doctor may also suggest that you drink less fluid to reduce swelling.
Nephrotic syndrome can increase your cholesterol and triglyceride levels, so try to eat a diet that’s low in saturated fat and cholesterol.
Although this condition causes you to lose protein in your urine, eating extra protein is not recommended. A high-protein diet can make nephrotic syndrome worse.
Complications and related conditions
Damage to the kidneys from nephrotic syndrome can lead to these complications:
- blood clots
- high cholesterol and triglycerides
- high blood pressure
- malnutrition
- a lack of red blood cells to carry oxygen to your body (anemia)
- chronic kidney disease
- acute kidney failure
- increased risk of infections such as pneumonia and meningitis
- underactive thyroid gland (hypothyroidism)
- coronary artery disease
Damage to the kidneys from nephrotic syndrome can lead to these complications:
- blood clots
- high cholesterol and triglycerides
- high blood pressure
- malnutrition
- a lack of red blood cells to carry oxygen to your body (anemia)
- chronic kidney disease
- acute kidney failure
- increased risk of infections such as pneumonia and meningitis
- underactive thyroid gland (hypothyroidism)
- coronary artery disease
How does it affect children?
Children can also get nephrotic syndrome. Just as in adults, there are two types of nephrotic syndrome that affect children:
- Primary nephrotic syndrome. This condition only affects the kidneys and is the most common type in children.
- Secondary nephrotic syndrome. This condition is caused by other diseases, such as diabetes or lupus.
In children, nephrotic syndrome causes these symptoms:
- fever, fatigue, irritability, and other signs of infection
- loss of appetite
- blood in the urine
- diarrhea
- high blood pressure
Kids with childhood nephrotic syndrome get more infections than usual. This is because the proteins that normally protect them from infection are lost in the urine. They may also have high blood cholesterol.
Treatments for childhood nephrotic syndrome include:
- corticosteroids or other medications that reduce the immune system response
- diuretics to remove extra fluid from the body
- blood pressure-lowering medications such as angiotensin receptor blockers or angiotensin-converting enzyme inhibitors
- medications to treat the cause of nephrotic syndrome, such as diabetes or lupus
Children who are born with nephrotic syndrome (congenital nephrotic syndrome), may eventually need a kidney transplant.
Children can also get nephrotic syndrome. Just as in adults, there are two types of nephrotic syndrome that affect children:
- Primary nephrotic syndrome. This condition only affects the kidneys and is the most common type in children.
- Secondary nephrotic syndrome. This condition is caused by other diseases, such as diabetes or lupus.
In children, nephrotic syndrome causes these symptoms:
- fever, fatigue, irritability, and other signs of infection
- loss of appetite
- blood in the urine
- diarrhea
- high blood pressure
Kids with childhood nephrotic syndrome get more infections than usual. This is because the proteins that normally protect them from infection are lost in the urine. They may also have high blood cholesterol.
Treatments for childhood nephrotic syndrome include:
- corticosteroids or other medications that reduce the immune system response
- diuretics to remove extra fluid from the body
- blood pressure-lowering medications such as angiotensin receptor blockers or angiotensin-converting enzyme inhibitors
- medications to treat the cause of nephrotic syndrome, such as diabetes or lupus
Children who are born with nephrotic syndrome (congenital nephrotic syndrome), may eventually need a kidney transplant.
Nephrotic Syndrome Diet
Overview
Nephrotic syndrome is a kidney disorder where the body releases too much protein into the urine. This reduces the amount of protein in your blood and affects how your body balances water.
Diet doesn’t cause nephrotic syndrome, but what you eat could worsen symptoms and cause other complications, such as high blood pressure, renal insufficiency, and increased fat in the bloodstream.
How diet affects nephrotic syndrome
Changing your diet is crucial to avoiding kidney damage. Because this disorder results from a loss of protein, some people might counteract this loss by eating a protein-rich diet. However, a high-protein diet isn’t recommended for nephrotic syndrome. Too much protein is dangerous because it can damage nephrons (the functioning units of kidneys) and cause renal insufficiency. Low to moderate protein intake is recommended, depending on the condition of your kidneys. Work with your doctor and a registered dietitian to determine your specific needs.
A low-sodium diet is also recommended with nephrotic syndrome. Too much sodium through diet can cause further fluid retention and salt retention, resulting in uncomfortable swelling and hypertension.
Because this disorder can also cause high levels of fat in the bloodstream, reducing your fat intake may prevent cardiovascular disease.
To help manage this condition, it’s important to understand what foods you should, and shouldn’t, eat.
Foods to eat on a nephrotic syndrome diet
- lean meats (poultry, fish, shellfish)
- dried beans
- peanut butter
- soybeans
- fresh or frozen fruit (apples, watermelons, pears, oranges, bananas)
- fresh or frozen vegetables (green beans, lettuce, tomatoes)
- low-sodium canned vegetables
- potatoes
- rice
- whole grains
- unsalted snacks (potato chips, nuts, popcorn)
- cottage cheese
- tofu
- milk
- butter or margarine
- processed cheeses
- high-sodium meats (bologna, ham, bacon, sausage, hot dogs)
- frozen dinners and entrées
- canned meats
- pickled vegetables
- salted potato chips, popcorn, and nuts
- salted bread
Restrictions and foods to avoid on a nephrotic syndrome diet
Keep in mind that certain seasonings and condiments also have a high salt content. Low-sodium options include ketchup, herbs and spices, vinegar, lemon juice, and no- or low-sodium seasoning blends.
Condiments and seasonings to avoid include Worcestershire sauce, bouillon cubes, olives, pickles, and soy sauce.
Diet tips for nephrotic syndrome
Monitoring your diet can be challenging, but it can also improve your health and alleviate symptoms of nephrotic syndrome. Here are a few tips to assist with dietary changes.
- Be mindful of protein intake. The recommended protein intake for nephrotic syndrome is 1 gram (g) per kilogram of body weight per day, which equals 0.45 g per pound per day. However, this amount may vary based on the current health of your kidneys.
- Limit sodium intake to 400 milligrams (mg) per meal (150 mg per snack), says Nephcure Kidney International (NKI). Read food labels and check sodium content before purchasing food items.
- Limit or avoid using seasonings with “salt” in the name. These have a higher salt content than herbs and spices. If a recipe calls for garlic salt, substitute with fresh garlic or garlic powder.
- Prepare meals at home. Restaurant meals may have a higher salt content. Research a restaurant’s nutritional menu beforehand, and choose entrees with under 400 mg of sodium. See if the restaurant can prepare your meal without salt.
- Cook with healthy oils such as olive or coconut oil.
- Remove salt from the dinner table.
- Choose fresh vegetables or canned vegetables with no added sodium or low sodium to reduce your sodium intake.
Complications of nephrotic syndrome
Complications can occur if you don’t follow these diet recommendations. If left untreated, complications of nephrotic syndrome include:
- blood clotting
- high blood cholesterol
- high blood triglycerides
- malnutrition
- weight loss
- vitamin D and calcium deficiency
- high blood pressure
- kidney failure
- chronic kidney disease
- infection due to loss of antibodies in urine
Preventing nephrotic syndrome
Nephrotic syndrome cannot be prevented, but treating an underlying kidney disease and making dietary changes may prevent worsening of symptoms. Treatment options may include blood pressure medication, diuretics, blood thinners, cholesterol-reducing medication, or a steroid if kidney disease causes inflammation. Your doctor may also refer you to a dietitian, an expert on diet and nutrition.
Outlook
The outlook for nephrotic syndrome depends on the cause. If your doctor can diagnose and treat an underlying kidney disease, your symptoms may gradually improve and never return. When nephrotic syndrome isn’t caused by kidney disease, the outlook varies. If you stick with a diet for nephrotic syndrome, it’s possible to control swelling and avoid long-term complications.
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