1. Nursing Instruction
  2. Overview
  3. Children’s Health
【Major Point】
  1. Steroids are usually prescribed for nephrotic syndrome in children.
  2. Common symptoms of childhood nephrotic syndrome include edema, proteinuria, hypoalbuminemia, and hyperlipidemia.
  3. Childhood nephrotic syndrome should eat a low-cholesterol and low-fat diet。
  4. During the course of steroid treatment, as the immune system may be suppressed, please do not go to the public place as possible.
  5. When severe edema is present, it needs to limit fluids and salt intake.
 
What is childhood nephrotic syndrome? 
Nephrotic syndrome is a collection of symptoms due to kidney damage. In most cases, the cause is unknown. It can be either a primary kidney disease or secondary to systemic diseases such as systemic lupus erythematosus, membranous nephropathy associated with hepatitis B virus, Henoch-Schönlein purpura, post streptococcal glomerulonephritis, and bacterial endocarditis…, etc.
 
 What are the common symptoms?
  1. Edema: Common symptoms as swelling of the eyelids, hands and legs, labia and scrotum. Sometimes, poor appetite is due to swelling of intestinal mucosa. Severe edema may cause ascites, pleural effusion, and hydrocephalus, which will affect the breath and consciousness.
  2. Albuminuria: loss protein in urine caused by damaged glomeruli.
  3. Hypoalbuminemia: is a consequence of largely urinary protein loss.
  4. Hyperlipidemia: Prolonged hypoalbuminemia stimulates lipoprotein synthesis by the liver which results in hyperlipidemia.
  5. The other symptoms: hypertension, decreased urine output, hematuria, symptoms of infection (e.g. spontaneous peritonitis or sepsis), blood coagulation abnormalities and produce vascular embolism (usually occurring to renal vein and lower extremity vein).
If your child has any of the above symptoms, it does not necessarily mean that it is nephrotic syndrome, please go to a pediatric nephrology clinic for further evaluation.
 
What are the common treatments?
  1. Medication: Steroids are usually prescribed. Immunosupressors only indicated in recurring nephrotic syndrome in corticosteroid intolerant people.  In the acute edema stage, the albumin and diuretics can be administered to improve edema. 
  2. Diet: Children who have nephrotic syndrome may lose a lot of essential proteins via urination, and may affect their growth. However, it is not necessarily to increase their protein intake. Once the disease is under control by medication, proteinuria will be improved. When children have serious edema or high blood pressure, they should have fluid-restricted and low-sodium diet, such as reducing the use of salts, avoiding pickled and salty food. In addition, they should eat low-cholesterol and low-fat diet which could prevent hyperlipidemia. It is better to eat fish, to avoid high-fat meat and organ meats, etc.
Principles of care:
  1. Observe and record the urine characteristics (color, bubbles) and urine volume. Measure body weight every day for reference of treatment.
  2. Diet: balance diet and follow the diet advice.
  3. Maintaining normal daily activities, and take a bed rest when edema get worse.
  4. Immunity will be suppressed while treating a child with corticosteroids or immunosuppressive medication, so do not go to the public place as possible.
  5. Follow the doctor’s instructions to take the medicine and regularly visit the clinics. Do not stop taking medicine by yourself. Also, do not take folk remedies.
 
References
  1. Dossier, C., Delbet, J. D., Boyer, O., Daoud, P., Mesples, B., Pellegrino, B., ... & Deschênes, G. (2019). Five-year outcome of children with idiopathic nephrotic syndrome: the NEPHROVIR population-based cohort study. Pediatric Nephrology, 34, 671-678. https://doi.org/10.1007/s00467-018-4149-2
  2. Hampson, K. J., Gay, M. L., & Band, M. E. (2021). Pediatric nephrotic syndrome: pharmacologic and nutrition management. Nutrition in Clinical Practice, 36(2), 331-343. https://doi.org/10.1002/ncp.10622
  3. Liu, I. D., Willis, N. S., Craig, J. C., & Hodson, E. M. (2019). Interventions for idiopathic steroid‐resistant nephrotic syndrome in children. Cochrane Database of Systematic Reviews, (11). https://doi.org/10.1002/14651858.CD003594.pub6
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    Taipei Veterans General Hospital 
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