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What is childhood nephrotic syndrome? 
Nephrotic syndrome is a group of symptoms that indicate kidney damage particularly in the glomeruli. The cause of disease is unknown. Nephrotic syndrome is classified into primary and secondary types. Primary nephrotic syndrome is the most common type, 90% patient caused by minimal change disease. Secondary  nephrotic syndrome is caused by systemic lupus erythematosus, hepatitis-B-virus-induced membranous nephritis, allergic purpura, poststreptococcal glomerulonephritis, and bacterial endocarditis etc.
 
Signs and symptoms of childhood nephrotic syndrome:
  1. Edema- characterized by eyelid and calf swelling. Sometimes, swollen intestinal mucosa may lead poor appetite. Severe edema may cause ascites, pleural effusion, and hydrocephalus, which will affect breathing and consciousness. Additionally, boys may experience scrotal edema.
  2. Albuminuria- loss of protein in urine caused by damaged glomeruli.
  3. Hypoalbuminemia- level of albumin in the blood is decline caused by large amount of protein loss in urine.
  4. Hyperlipidemia- long term hyperlipidemia promotes excessive production of lipoprotein in the liver, resulting in hyperlipidemia.
  5. Other symptoms- Hypertension, decreased urine output, hematuria,symptoms of infection(e.g. spontaneous bacterial peritonitis or sepsis), blood coagulation abnormalities and vascular embolism (more likely to occur in renal vein or lower extremity vein).
Children who has symptoms listed above may not  have childhood nephrotic syndrome. Please take your child to Division of Pediatric Nephrology for further evaluation.
 
Treatments:
  1. Medication-Childhood nephrotic syndrome is usually treated with corticosteroids.  For frequent recurrence or adverse reaction in relation to corticosteroid treatment, doctors will use immunosuppressive drug. During acute edema stage, swelling would be improved by the use of albumin and diuretics.
  2. Diet- Children who have nephrotic syndrome may lose large amount of essential proteins in the urine, and it may affect their growth. However, it is not necessary to increase protein intake because a high protein diet may increase kidney’s workload. When children suffers serious edema or high blood pressure, they should have fluid-restricted and low-sodium diet i.e, reduce the use of seasonings, and avoid pickled and salty food. In addition, they should eat a low-cholesterol and low-fat diet which could prevent hyperlipidemia.
 
Home care:
  1. Measure body weight every day. Monitor the urine characteristics (color, bubbles) and volume references of treatment for the doctor. This can be references of treatment for the doctor.
  2. Keep a balance diet and follow dietary advice.
  3. Maintain normal daily activities and have bed rest when edema worsens.
  4. Immunity will be suppressed when receiving corticosteroids or immunosuppressive drug for treatment . To avoid infection, please do not go to the public place as possible.
  5. Follow doctor’s instructions to take the medicine and regular visit the clinics. Do not stop taking the medicine abruptly or believe in folk prescription. This can cause treatment delays and disease recurrent.
References
  1. Dossier, C., Delbet, J. D., Boyer, O., Daoud, P., Mesples, B., Pellegrino, B., See, H., Benoist, G., Chace,A.,
    Larakeb, A., Hogan, J., & Deschênes, G. (2019). Five-year outcome of children with idiopathic nephrotic syndrome: the NEPHROVIR population-based cohort study. Pediatric Nephrology, 34,671-678.
  2. 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, 1-110. https://doi.org/10.1002/14651858.CD003594.pub6
  3. Noone, D. G., Iijima, K., & Parekh, R. (2018). Idiopathic nephrotic syndrome in children. The Lancet, 392(10141), 61-74. https://doi.org/10.1016/S0140-6736(18)30536-1
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    Taipei Veterans General Hospital 
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    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
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