What is childhood nephrotic syndrome? 
Nephrotic syndrome is a group of symptoms that indicate kidney damage particularly in the glomeruli. Most of the causes are unknown. Nephrotic syndrome is divided into primary and secondary types. The most common type of childhood nephrotic syndrome is primary type. 90% of childhood nephrotic syndrome have pathology of minimal change disease. Secondary type of childhood nephrotic syndrome is caused by other diseases, like systemic lupus erythematosus, hepatitis B virus induced membranous nephritis, allergic purpura, poststreptococcal glomerulonephritis and bacterial endocarditis, etc.
 
The signs and symptoms of childhood nephrotic syndrome:
  1. edema-Common symptoms are eyelid and calf swelling. Sometimes, poor appetite is due to swelling of the intestinal mucosa. Boys may experience scrotal edema. 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—Hypoalbuminemia is largely a consequence of 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). 
Those children who experience symptoms listed above may not necessarily suffer from the childhood nephrotic syndrome. Please take your child to Division of Pediatric Nephrology for further evaluation.
 
Treatments:
  1. Medication-Childhood nephrotic syndrome are usually treated with corticosteroids. For adverse reactions to corticosteroid treatment, the doctors would treat with immunosuppressive drug at the same time. During acute edema stage, the swelling would be improved by treatment with albumin and diuretics.
  2. Diet and Nutrition-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 because a high protein diet may increase the kidneys'workload. When children have serious edema or high blood pressure, they should have fluid-restricted and low-sodium diet, such as reducing the use of seasonings, and avoiding pickled and salty food. In addition, they should eat low-cholesterol and low-fat diet which could prevent hyperlipidemia.
 
Home care:
  1. Observing the urine volume and characteristics (color, bubbles) and measure body weight every day for reference of treatment.
  2. Following 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. Following the doctor’s instructions to take the medicine and do not abruptly stop taking. Also, regularly visit the clinics is needed. 
 
References
  1. Lieberman, K. V., & Pavlova-Wolf, A. (2017). Adrenocorticotropic hormone therapy for the treatment of idiopathic nephrotic syndrome in children and young adults: a systematic review of early clinical studies with contemporary relevance. Journal of Nephrology, 30(1), 35-44. doi:10.1007/s40620-016-0308-3
  2. Marzuillo, P., Guarino, S., Apicella, A., Marotta, R., Tipo, V., Perrone, L., & Montini, G. (2017). Assessment of volume status and appropriate fluid replenishment in the setting of nephrotic syndrome. The Journal of Emergency Medicine, S0736-4679(16), 30540-30546. doi:10.1016/j.jemermed.2016.07.089.
  3. Pasini, A., Aceto, G., Ammenti, A., Ardissino, G., Azzolina, V., Bettinelli, A.,… Montini, G. (2015). Best practice guidelines for idiopathic nephrotic syndrome: recommendations versus reality. Pediatric Nephrology, 30(1), 91-101. doi: 10.1007/s00467-014-2903-7
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