Nephrotic Syndrome

Nephrotic syndrome (NS) is not a disease in itself; rather, it is a group of kidney-related findings in your child’s body that indicate damaged glomeruli (kidney’s filter) resulting in too much release of protein from the blood into the urine. This leads to edema (swelling), high cholesterol levels, high levels of protein in urine (proteinuria) and low levels of protein in blood (hypoalbuminemia). Nephrotic syndrome can be categorized into two subtypes, which further divide into various diseases and circumstances that damage the glomeruli. These include:

  • Primary or idiopathic NS that occur for unknown reasons. These include:

    • ​Minimal change disease which is the most common cause of NS in children, resulting in abnormal kidney function. It is categorized by the appearance of damaged kidney tissues under the microscope, which appears to be almost normal or show no change

    • Focal segmental glomerulosclerosis which is characterized by scarring that is scattered across the glomeruli

    • Membranous nephropathy which is a kidney disorder resulting in the thickening of the membrane within the glomeruli

  • Secondary NS that is caused by another medical disorder or treatment for another disease. These include:

    • ​Diabetes

    • Systemic lupus erythematosus (SLE) (an autoimmune disease which causes your child’s immune system to attack the kidneys, particularly the glomeruli)

    • Hepatitis B and hepatitis C

    • Medications such as corticosteroids

    • Blood clot in kidney veins

    • Human immunodeficiency virus (HIV)

Nephrotic syndrome can increase your child’s risk of infection and blood clots. It always affects both kidneys and usually appears in the early years of your child’s life. Most children with this disorder outgrow it by young adulthood. ​

​Signs and symptoms due to nephrotic syndrome may include:

  • Weight gain due to fluid retention

  • Fatigue

  • Loss of appetite

  • Pain and swelling in abdomen

  • Foamy appearance of urine

  • Edema (swelling due to fluid accumulation)​​

Set an appointment with one of our highly skilled doctors at the Children's Hospital Service Line at The Aga Khan University Hospital the only internationally accredited hospital in Pakistan, if you notice any of the symptoms in your child that cause you concern.​​

Your time with your doctor maybe limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.​​

​The diagnosis usually begins by physical examination of your child. The doctor may then recommend the following tests for an accurate diagnosis:

  • Complete blood count (CBC): One or more parameters related to red blood cells, white blood cells and platelets might be affected in this condition, giving a clue towards etiology and further diagnostic approach. Therefore, it is an ancillary test in the diagnostic workup of this disease.​
  • Urinalysis to determine the presence of proteins in the urine. You may be asked to collect your child’s urine samples over the period of twenty-four hours for an accurate result. Elevated levels of protein indicate nephrotic syndrome

  • Blood test, to check the protein levels, which may show low levels of protein albumin and overall decreased levels of blood protein

  • Ultrasound to obtain images of the kidneys and the surrounding structures to detect any signs of damage

  • A kidney biopsy in which a sample of the kidney cells is extracted using a special needle and studied under the microscope to determine the cause and extent of damage to the kidneys​​.

Disclaimer: Kindly consult your physician before getting the above-mentioned tests.

At the Children's Hospital Service Line at The Aga Khan University Hospital, our doctors real​ize how difficult it can be for you and your child to learn about the diagnosis of nephrotic syndrome. Therefore, our esteemed group of doctors will cater to your child’s every requirement as they carry out the treatment procedure.

The treatment for your child will depend on the underlying cause of NS. For children with primary NS, the doctors may prescribe the following medications:​

  • Immune system-suppressing medications, (like steroids) , which work by controlling the immune system in order to decrease the inflammation that is caused by minimal change disease

  • Diuretics to assist in controlling the swelling by increasing the fluid output by the kidney

  • Medications for controlling blood pressure and medications which prevent the leakage of protein into the urine

  • Teaching parents home monitoring of blood pressure and urine (dipping stick)

For secondary NS, the doctor may suggest the following treatments:

  • Antibiotics for infection

  • Medications to treat SLE, HIV or diabetes

  • Changing or stopping certain medications that are believed to be causing NS​​

​The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.​

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.​

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.​​

​​The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.