1. Nursing Instruction
  2. Overview
  3. Children’s Health
【Major Point】
  1. Nephrotic Syndrome is a common pediatric glomerular disease
  2. Common symptoms include edema, foamy urine, and hyperlipidemia.
  3. Children with Nephrotic Syndrome should follow a low-sodium diet with adequate protein and limited fat intake.
  4. During steroid treatment, their immunity may be reduced, so they should avoid crowded public places.
  5. In children with severe edema, water and salt intake may need to be restricted.

I. What is Nephrotic Syndrome in Children?
Nephrotic Syndrome is a common glomerular disease among school-aged children. The exact cause is unknown, but it may be related to immune system abnormalities or genetic mutations. In some cases, the syndrome is caused by other diseases or infections, such as systemic lupus erythematosus, membranous nephritis associated with hepatitis B virus, allergic purpura, acute post-streptococcal glomerulonephritis, bacterial endocarditis, etc.
 
 II. What are the symptoms of Nephrotic Syndrome in Children?
  1. Edema: Common areas include the eyelids hands, legs, and the labia or scrotum. Swelling of the intestinal mucosa may cause decreased appetite. In severe cases, ascites, pleural effusion, and hydrocephalus may occur, further impacting breathing.
  2. Foamy urine: Damage to the glomeruli causes excessive protein loss in the urine, resulting in foamy urine.
  3. Hypoalbuminemia: Large amounts of protein lost through urine lead to low albumin levels in the blood.
  4. Hyperlipidemia: Persistent low albumin levels stimulate the liver to produce excessive lipoproteins, causing high blood lipids.
  5. Infection: Significant loss of immunoglobulins through urine increases the risk of infection, such as by Streptococcus pneumoniae, invasive Haemophilus Group B, or Group A Streptococcus, which may cause spontaneous peritonitis, sepsis, etc.
  6. Others: Hypertension, reduced urine output, hematuria, and abnormal blood clotting which may increase the risk of thrombosis (commonly in the renal veins and lower limb veins).
The presence of the above symptoms does not necessarily indicate Nephrotic Syndrome. If your child experiences these symptoms, please consult a pediatric internal medicine or pediatric immunology and nephrology specialist.
 
III. How is Nephrotic Syndrome Treated in Children?
  1. Primary treatment: Steroids are used as the first-line treatment.
  2. If the response to steroids is inadequate, pediatricians may consider additional treatments such as immunosuppressants or anti-rejection medications to help control the condition.

IV. How to care for a Child with Nephrotic Syndrome?
  1. Regular monitoring: Regularly check your child’s weight, blood pressure, and changes in proteinuria (keeping urine test strips at home is recommended). These measures provide important information for the pediatrician’s treatment.
  2.  Dietary adjustments: Follow a low-sodium, adequate-protein, low-fat, and balanced diet.
    A. Low-sodium diet:Restrict sodium intake only when blood pressure is high or edema is severe. For children with chronic kidney disease or proteinuria, blood pressure should ideally be controlled below 130/80 mmHg.
    B. Adequate protein intake: A daily intake of 0.8–1.0 g/kg is recommended. For example, a 20-kg child should consume 16-20g of protein per day. Avoid excessive protein to prevent unnecessary burden on the kidneys.
    C. Low-fat diet: Choose foods that are low in fat and cholesterol .
    D. Sufficient calories: Consume 35 kcal/kg/day. For example, for a 20-kg child should consume about around 700kcal.
  3. Moderate exercise: Bed rest is only necessary when edema is severe for edema.
  4. Infection prevention: When taking steroids or immunosuppressive medications for treatment, immunity may be reduced. Children should avoid visiting crowded public places; they should wash their hands frequently, wear a mask, and refrain from eating undercooked food.
  5. Follow the physician’s instructions for all medications and attend regular follow-ups. Do not discontinue medication on your own or rely on folk remedies; this may delay treatment or lead to recurrence.
References
  1. 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
  2. Rodriguez-Ballestas, E., & Reid-Adam, J. (2022). Nephrotic syndrome. Pediatrics in review, 43(2), 87-99. https://doi.org/10.1542/pir.2020-001230
  3. Vivarelli, M., Gibson, K., Sinha, A., & Boyer, O. (2023). Childhood nephrotic syndrome. The Lancet, 402(10404), 809-824.
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    Taipei Veterans General Hospital 
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