4. Nephrotic Syndrome Adults 508

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Nephrotic

Syndrome in AdultsNational Kidney and Urologic Diseases Information ClearinghouseNational Kidney and Urologic Diseases Information Clearinghouse

What is nephroticsyndrome?Nephrotic syndrome is a collection of

symptoms that indicate kidney damage.Nephrotic syndrome includes the following:

proteinurialarge amounts of proteinin the urine

hyperlipidemiahigher than normal fatand cholesterol levels in the blood

edema, or swelling, usually in the legs,feet, or ankles and less often in thehands or face

hypoalbuminialow levels of albumin

in the bloodAlbumin is a protein that acts like a sponge,drawing extra fluid from the body into thebloodstream where it remains until removed

by the kidneys. When albumin leaks into theurine, the blood loses its capacity to absorbextra fluid from the body, causing edema.

Nephrotic syndrome results from a problemwith the kidneys filters, called glomeruli.Glomeruli are tiny blood vessels in thekidneys that remove wastes and excess fluidsfrom the blood and send them to the bladderas urine.

As blood passes through healthy kidneys, theglomeruli filter out the waste products andallow the blood to retain cells and proteinsthe body needs. However, proteins fromthe blood, such as albumin, can leak intothe urine when the glomeruli are damaged.

In nephrotic syndrome, damaged glomeruliallow 3 grams or more of protein to leak intothe urine when measured over a 24-hourperiod, which is more than 20 times theamount that healthy glomeruli allow.

Kidneys

Bladder

Ureters

Ureter(waste and fluids

go out in urine)

Glomeruli(tiny filters in

the kidney)

Vein(clean blood

leaves the kidney)

Artery(blood and waste

enter the kidney)

As blood passes through healthy kidneys, the glomeruli filter out the waste products and allow the blood toretain cells and proteins the body needs.


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2 Nephrotic Syndrome in Adults

What causes nephroticsyndrome?Nephrotic syndrome can be caused by dis-eases that affect only the kidneys, such asfocal segmental glomerulosclerosis (FSGS)or membranous nephropathy. Diseases thataffect only the kidneys are called primarycauses of nephrotic syndrome. The glom-eruli are usually the targets of these diseasesfor reasons that are not fully understood. InFSGSthe most common primary cause

of nephrotic syndromescar tissue formsin parts of the glomeruli. In membranousnephropathy, immune molecules form harm-ful deposits on the glomeruli.

Nephrotic syndrome can also be caused bysystemic diseases, which are diseases thataffect many parts of the body, such as dia-betes or lupus. Systemic diseases that affectthe kidneys are called secondary causes ofnephrotic syndrome. More than 50 percentof nephrotic syndrome cases in adults have

secondary causes, with diabetes being themost common.1

1Nephrotic Syndrome. The Merck ManualsOnline Medical Library. www.merckmanuals.com/professional/genitourinary_disorders/glomerular_disorders/overview_of_nephrotic_syndrome.html?qt=Nephrotic Syndrome in Adults&alt=sh.Updated March 2013. Accessed December 4, 2013.

What are the signs andsymptoms of nephroticsyndrome?In addition to proteinuria, hyperlipidemia,edema, and hypoalbumina, people withnephrotic syndrome may experience

weight gain

fatigue

foamy urine

loss of appetite

What are the complicationsof nephrotic syndrome?The loss of different proteins from the bodycan lead to a variety of complications inpeople with nephrotic syndrome. Bloodclots can form when proteins that normallyprevent them are lost through the urine.Blood clots can block the flow of blood andoxygen through a blood vessel. Loss ofimmunoglobulinsimmune system proteinsthat help fight disease and infectionleads

to an increased risk of infections. Theseinfections include pneumonia, a lung infec-tion; cellulitis, a skin infection; peritonitis, anabdominal infection; and meningitis, a brainand spine infection. Medications given totreat nephrotic syndrome can also increasethe risk of these infections. Other complica-tions of nephrotic syndrome include

hypothyroidisma condition in whichthe thyroid gland does not produceenough thyroid hormone to meet the

bodys needs anemiaa condition in which red blood

cells are fewer or smaller than normal,which means less oxygen is carried tothe bodys cells

coronary artery disease, also calledcoronary heart diseaseheart diseasecaused by narrowing of the arteries thatsupply blood to the heart

high blood pressure, also calledhypertensiona condition in which

blood flows through the blood vesselswith a force greater than normal

acute kidney injurysudden and tem-porary loss of kidney function
http://www.merckmanuals.com/professional/genitourinary_disorders/glomerular_disorders/nephrotic_syndrome.html?qt=&sc=&althttp://www.merckmanuals.com/professional/genitourinary_disorders/glomerular_disorders/nephrotic_syndrome.html?qt=&sc=&althttp://www.merckmanuals.com/professional/genitourinary_disorders/glomerular_disorders/nephrotic_syndrome.html?qt=&sc=&althttp://www.merckmanuals.com/professional/genitourinary_disorders/glomerular_disorders/nephrotic_syndrome.html?qt=&sc=&alt


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How is nephrotic syndromediagnosed?Urine samples are taken to diagnose peoplesuspected of having nephrotic syndrome.

Nephrotic syndrome is diagnosed when largeamounts of protein are found in the urine.The blood protein albumin makes up muchof the protein that is lost, though many otherimportant proteins are also lost in nephroticsyndrome.

The presence of albumin in the urine can bedetected with a dipstick test performed on aurine sample. The urine sample is collectedin a special container in a health care pro-

viders office or commercial facility and canbe tested in the same location or sent to a labfor analysis. For the test, a nurse or tech-nician places a strip of chemically treatedpaper, called a dipstick, into the urine.Patches on the dipstick change color whenprotein is present in urine.

A more precise measurement is usuallyneeded to confirm the diagnosis. Either asingle urine sample or a 24-hour collectionof urine can be sent to a lab for analysis.With the single urine sample, the lab mea-sures both albumin and creatinine, a wasteproduct of normal muscle breakdown. Thecomparison of the measurements is called aurine albumin-to-creatinine ratio. A urinesample containing more than 30 milligramsof albumin for each gram of creatinine maysignal a problem. With a 24-hour collection

of urine, the lab measures only the amountof albumin present. The single urine sampleis easier to collect than the 24-hour sampleand is usually sufficient to confirm diagnosis,though the 24-hour collection may be used insome cases.

Once nephrotic syndrome is diagnosed,blood tests are usually needed to check forsystemic diseases that may be causing thenephrotic syndrome and to find out how wellthe kidneys are working overall. A bloodtest involves drawing blood at a health careproviders office or commercial facility andsending the sample to a lab for analysis.

Though blood tests can point toward sys-temic diseases, a kidney biopsy is usuallyneeded to diagnose the specific underlying

disease causing the nephrotic syndrome andto determine the best treatment. A kidneybiopsy is a procedure that involves taking apiece of kidney tissue for examination with amicroscope. Kidney biopsies are performedby a health care provider in a hospital withlight sedation and local anesthetic. A biopsyis often not needed for a person with dia-betes because the persons medical historyand lab tests may be enough to diagnose theproblem as being a result of diabetes.

How is nephrotic syndrometreated?Treating nephrotic syndrome includesaddressing the underlying cause as well astaking steps to reduce high blood pressure,edema, high cholesterol, and the risks ofinfection. Treatment usually includes medi-cations and changes in diet.

Medications that lower blood pressure canalso significantly slow the progression of

kidney disease causing nephrotic syndrome.Two types of blood pressure lowering medi-cations, angiotensin-converting enzyme(ACE) inhibitors and angiotensin receptorblockers (ARBs), have proven effective inslowing the progression of kidney disease byreducing the pressure inside the glomeruli



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and thereby reducing proteinuria. Manypeople require two or more medications tocontrol their blood pressure. In addition toan ACE inhibitor or an ARB, a diureticamedication that aids the kidneys in remov-ing fluid from the bloodcan also be usefulin helping to reduce blood pressure as wellas edema. Beta blockers, calcium channelblockers, and other blood pressure medica-tions may also be needed.

Statin medications may be given to lowercholesterol.

People with nephrotic syndrome shouldreceive the pneumococcal vaccine, whichhelps protect against a bacterium that com-monly causes infection, and yearly flu shots.

Blood thinning medications are usually onlygiven to people with nephrotic syndrome

who develop a blood clot; these medicationsare not used as a preventive measure.

Nephrotic syndrome may go away once theunderlying cause has been treated. Moreinformation about treating the underly-ing causes of nephrotic syndrome canbe found in the National Kidney andUrologic Diseases Information Clearing-house publication Glomerular Diseases at

www.kidney.niddk.nih.gov.

Eating, Diet, and NutritionEating, diet, and nutrition have not beenshown to play a role in causing or preventingnephrotic syndrome in adults. For people

who have developed nephrotic syndrome,limiting intake of dietary sodium, often fromsalt, and fluid may be recommended to helpreduce edema. A diet low in saturated fatand cholesterol may also be recommended tohelp control hyperlipidemia.

Points to Remember Nephrotic syndrome includes the

following:

proteinurialarge amounts ofprotein in the urine

hyperlipidemiahigher thannormal fat and cholesterol levelsin the blood

edema, or swelling, usually in thelegs, feet, or ankles and less oftenin the hands or face

hypoalbuminialow levels albu-min in the blood

Primary causes of nephrotic syn-drome are diseases that affect onlythe kidneys, such as focal segmentalglomerulosclerosis (FSGS). Sec-ondary causes of nephrotic syn-drome are diseases that affect manyparts of the body, such as diabetes.

In addition to proteinuria, hyperlip-idemia, edema, and hypoalbumina,people with nephrotic syndromemay experience

weight gain

fatigue

foamy urine

loss of appetite

The loss of different proteins fromthe body can lead to a variety

of complications in people withnephrotic syndrome.

Treating nephrotic syndromeincludes addressing the underlyingcause and taking steps to reducehigh blood pressure, edema, highcholesterol, and the risks of infec-tion. Treatment usually includesmedications and changes in diet.

http://www.kidney.niddk.nih.gov/http://www.kidney.niddk.nih.gov/


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Hope through ResearchIn recent years, researchers have learnedmuch about kidney disease. The NationalInstitute of Diabetes and Digestive andKidney Diseases (NIDDK) sponsors severalprograms aimed at understanding glomeru-lar diseases such as FSGS and membranousnephropathy, which are primary causes ofnephrotic syndrome. The NIDDK also stud-ies diseases such as lupus and diabetes, whichare secondary causes of nephrotic syndrome.Finding treatments for these underlyingcauses will help prevent nephrotic syndromeor stop its progression.

Participants in clinical trials can play a moreactive role in their own health care, gainaccess to new research treatments beforethey are widely available, and help othersby contributing to medical research. Forinformation about current studies, visit

www.ClinicalTrials.gov.

For More InformationAmerican Kidney Fund6110 Executive Boulevard, Suite 1010Rockville, MD 20852Phone: 18006388299Internet: www.kidneyfund.org

National Heart, Lung, and Blood Institute

Health Information Center

P.O. Box 30105Bethesda, MD 208240105Phone: 3015928573

TTY: 2406293255Fax: 2406293246Email: [email protected]: www.nhlbi.nih.gov

National Kidney Foundation30 East 33rd StreetNew York, NY 10016Phone: 18006229010 or 2128892210Fax: 2126899261Internet: www.kidney.org

The NephCure Foundation

15 Waterloo AvenueBerwyn, PA 19312Phone: 18666374287 or 6105400186Email: [email protected]: www.nephcure.org

The Nephrotic Syndrome Study Network

(NEPTUNE)

University of Michigan206 Simpson Memorial Institute102 Observatory

Ann Arbor, MI 48109Phone: 18779NEPTUNE

(18779637886) or 7346155021Fax: 7346156005Email: [email protected]: www.neptune-study.org

AcknowledgmentsPublications produced by the Clearinghouseare carefully reviewed by both NIDDK sci-entists and outside experts. This publication

was reviewed by Patrick Gipson, M.D., andMatthias Kretzler, M.D., both of the Univer-sity of Michigan Medical Center.

You may also find additional information about this

topic by visiting MedlinePlus atwww.medlineplus.gov.

This publication may contain information aboutmedications. When prepared, this publicationincluded the most current information available.For updates or for questions about any medications,contact the U.S. Food and Drug Administration toll-free at 1888INFOFDA (18884636332) or visitwww.fda.gov. Consult your health care provider formore information.

http://www.clinicaltrials.gov/http://www.kidneyfund.org/mailto:[email protected]://www.nhlbi.nih.gov/http://www.kidney.org/mailto:[email protected]://www.nephcure.org/mailto:[email protected]://www.neptune-study.org/http://www.medlineplus.gov/http://www.medlineplus.gov/http://www.fda.gov/http://www.clinicaltrials.gov/http://www.kidneyfund.org/mailto:[email protected]://www.nhlbi.nih.gov/http://www.kidney.org/mailto:[email protected]://www.nephcure.org/mailto:[email protected]://www.neptune-study.org/http://www.medlineplus.gov/http://www.fda.gov/


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National Kidney andUrologic DiseasesInformation Clearinghouse

3 Information WayBethesda, MD 208923580Phone: 18008915390TTY: 18665691162Fax: 7037384929Email: [email protected]: www.kidney.niddk.nih.gov

The National Kidney and Urologic DiseasesInformation Clearinghouse (NKUDIC)is a service of the National Institute ofDiabetes and Digestive and Kidney Diseases(NIDDK). The NIDDK is part of theNational Institutes of Health of the U.S.Department of Health and Human Services.Established in 1987, the Clearinghouseprovides information about diseases of thekidneys and urologic system to people withkidney and urologic disorders and to theirfamilies, health care professionals, and the

public. The NKUDIC answers inquiries,develops and distributes publications, and

works closely with professional and patientorganizations and Government agenciesto coordinate resources about kidney andurologic diseases.

This publication is not copyrighted. The Clearinghouseencourages users of this publication to duplicate anddistribute as many copies as desired.

This publication is available at.

www.kidney.niddk.nih.gov

NIH Publication No. 124624

March 2012

The NIDDK prints on recycled paper with bio-based ink.
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