Nephrotic

Syndrome in Adults
National Kidney and Urologic Diseases Information Clearinghouse National Kidney and Urologic Diseases Information Clearinghouse
What is nephrotic
syndrome?
Nephrotic syndrome is a collection of
symptoms that indicate kidney damage.
Nephrotic syndrome includes the following:
proteinurialarge amounts of protein
in the urine
hyperlipidemiahigher than normal fat
and cholesterol levels in the blood
edema, or swelling, usually in the legs,
feet, or ankles and less often in the
hands or face
hypoalbuminialow levels of albumin
in the blood
Albumin is a protein that acts like a sponge,
drawing extra uid from the body into the
bloodstream where it remains until removed
by the kidneys. When albumin leaks into the
urine, the blood loses its capacity to absorb
extra uid from the body, causing edema.
Nephrotic syndrome results from a problem
with the kidneys lters, called glomeruli.
Glomeruli are tiny blood vessels in the
kidneys that remove wastes and excess uids
from the blood and send them to the bladder
as urine.
As blood passes through healthy kidneys, the
glomeruli lter out the waste products and
allow the blood to retain cells and proteins
the body needs. However, proteins from
the blood, such as albumin, can leak into
the urine when the glomeruli are damaged.
In nephrotic syndrome, damaged glomeruli
allow 3 grams or more of protein to leak into
the urine when measured over a 24-hour
period, which is more than 20 times the
amount that healthy glomeruli allow.

Kidneys
Bladder
Ureters
Ureter
(waste and uids
go out in urine)

Glomeruli
(tiny lters in
the kidney)
Vein
(clean blood
leaves the kidney)
Artery
(blood and waste
enter the kidney)

As blood passes through healthy kidneys, the glomeruli filter out the waste products and allow the blood to
retain cells and proteins the body needs.
2 Nephrotic Syndrome in Adults
What causes nephrotic
syndrome?
Nephrotic syndrome can be caused by dis-
eases that affect only the kidneys, such as
focal segmental glomerulosclerosis (FSGS)
or membranous nephropathy. Diseases that
affect only the kidneys are called primary
causes of nephrotic syndrome. The glom-
eruli are usually the targets of these diseases
for reasons that are not fully understood. In
FSGSthe most common primary cause
of nephrotic syndromescar tissue forms
in parts of the glomeruli. In membranous
nephropathy, immune molecules form harm-
ful deposits on the glomeruli.
Nephrotic syndrome can also be caused by
systemic diseases, which are diseases that
affect many parts of the body, such as dia-
betes or lupus. Systemic diseases that affect
the kidneys are called secondary causes of
nephrotic syndrome. More than 50 percent
of nephrotic syndrome cases in adults have
secondary causes, with diabetes being the
most common.
1

1
Nephrotic Syndrome. The Merck Manuals
Online Medical Library. www.merckmanuals.com/
professional/genitourinary_disorders/glomerular_
disorders/overview_of_nephrotic_syndrome.
html?qt=Nephrotic Syndrome in Adults&alt=sh.
Updated March 2013. Accessed December 4, 2013.
What are the signs and
symptoms of nephrotic
syndrome?
In addition to proteinuria, hyperlipidemia,
edema, and hypoalbumina, people with
nephrotic syndrome may experience
weight gain
fatigue
foamy urine
loss of appetite
What are the complications
of nephrotic syndrome?
The loss of different proteins from the body
can lead to a variety of complications in
people with nephrotic syndrome. Blood
clots can form when proteins that normally
prevent them are lost through the urine.
Blood clots can block the ow of blood and
oxygen through a blood vessel. Loss of
immunoglobulinsimmune system proteins
that help ght disease and infectionleads
to an increased risk of infections. These
infections include pneumonia, a lung infec-
tion; cellulitis, a skin infection; peritonitis, an
abdominal infection; and meningitis, a brain
and spine infection. Medications given to
treat nephrotic syndrome can also increase
the risk of these infections. Other complica-
tions of nephrotic syndrome include
hypothyroidisma condition in which
the thyroid gland does not produce
enough thyroid hormone to meet the
bodys needs
anemiaa condition in which red blood
cells are fewer or smaller than normal,
which means less oxygen is carried to
the bodys cells
coronary artery disease, also called
coronary heart diseaseheart disease
caused by narrowing of the arteries that
supply blood to the heart
high blood pressure, also called
hypertensiona condition in which
blood ows through the blood vessels
with a force greater than normal
acute kidney injurysudden and tem-
porary loss of kidney function











































































How is nephrotic syndrome
diagnosed?
Urinesamplesaretakentodiagnosepeople
suspectedofhavingnephroticsyndrome.
Nephroticsyndromeisdiagnosedwhenlarge
amountsofproteinarefoundintheurine.
Thebloodproteinalbuminmakesupmuch
oftheproteinthatislost,thoughmanyother
importantproteinsarealsolostinnephrotic
syndrome.
Thepresenceofalbuminintheurinecanbe
detectedwith adipsticktestperformed on a
urinesample. Theurinesampleiscollected
in aspecialcontainer in ahealthcarepro-
vidersofceorcommercialfacilityandcan
betested in thesamelocation orsent to a lab
foranalysis. For thetest, anurse ortech-
nicianplacesastripofchemicallytreated
paper,called adipstick,intotheurine.
Patchesonthedipstickchangecolorwhen
proteinispresentinurine.
A moreprecisemeasurementisusually
neededtoconrmthediagnosis. Either a
singleurinesampleor a24-hourcollection
ofurinecanbesenttoalabforanalysis.
Withthesingleurinesample,thelabmea-
suresbothalbuminandcreatinine, awaste
productofnormalmusclebreakdown. The
comparison of themeasurements iscalled a
urinealbumin-to-creatinineratio. A urine
samplecontainingmorethan30milligrams
ofalbuminforeachgramofcreatininemay
signal aproblem. With a24-hourcollection
ofurine,thelabmeasuresonlytheamount
ofalbuminpresent. Thesingleurinesample
iseasiertocollectthanthe24-hoursample
andisusuallysufcienttoconrmdiagnosis,
thoughthe24-hourcollectionmaybeusedin
somecases.
Oncenephroticsyndromeisdiagnosed,
bloodtestsareusuallyneededtocheckfor
systemicdiseasesthatmaybecausingthe
nephroticsyndromeandtondouthowwell
thekidneysareworkingoverall. A blood
testinvolvesdrawingbloodat ahealthcare
providersofceorcommercialfacilityand
sendingthesampleto alabforanalysis.
Thoughbloodtestscanpointtowardsys-
temicdiseases, akidneybiopsy isusually
neededtodiagnosethespecicunderlying
diseasecausingthenephroticsyndromeand
todeterminethebesttreatment. A kidney
biopsy is aprocedurethatinvolvestaking a
piece ofkidneytissue forexaminationwith a
microscope. Kidneybiopsiesareperformed
by ahealthcareprovider in ahospitalwith
lightsedationandlocalanesthetic. A biopsy
isoftennotneededfor apersonwithdia-
betesbecausethepersonsmedicalhistory
andlabtestsmaybeenoughtodiagnosethe
problem as being aresult ofdiabetes.
How is nephrotic syndrome
treated?
Treatingnephroticsyndromeincludes
addressingtheunderlyingcauseaswellas
takingstepstoreducehighbloodpressure,
edema,highcholesterol,andtherisksof
infection. Treatmentusuallyincludesmedi-
cationsandchangesindiet.
Medicationsthatlowerbloodpressurecan
alsosignicantlyslowtheprogressionof
kidneydiseasecausingnephroticsyndrome.
Twotypesofbloodpressureloweringmedi-
cations,angiotensin-convertingenzyme
(ACE)inhibitorsandangiotensinreceptor
blockers(ARBs),haveproveneffectivein
slowing theprogression ofkidneydisease by
reducingthepressureinsidetheglomeruli
3 NephroticSyndrome in Adults









































































andtherebyreducingproteinuria. Many
peoplerequiretwoormoremedicationsto
controltheirbloodpressure. Inadditionto
an ACEinhibitororanARB, adiuretica
medicationthataidsthekidneysinremov-
inguidfromthebloodcanalsobeuseful
inhelpingtoreducebloodpressureaswell
asedema. Betablockers,calciumchannel
blockers,andotherbloodpressuremedica-
tionsmayalsobeneeded.
Statinmedicationsmaybegiventolower
cholesterol.
Peoplewithnephroticsyndromeshould
receivethepneumococcalvaccine,which
helpsprotectagainst abacteriumthatcom-
monlycausesinfection,andyearlyushots.
Bloodthinningmedicationsareusuallyonly
giventopeoplewithnephroticsyndrome
whodevelop abloodclot;thesemedications
arenotusedasapreventivemeasure.
Nephroticsyndromemaygoawayoncethe
underlyingcausehasbeentreated. More
informationabouttreatingtheunderly-
ingcausesofnephroticsyndromecan
befoundintheNationalKidneyand
UrologicDiseasesInformationClearing-
housepublicationGlomerular Diseases at
www.kidney.niddk.nih.gov.
Eating, Diet, and Nutrition
Eating,diet,andnutritionhavenotbeen
shown to play arole incausing orpreventing
nephroticsyndromeinadults. Forpeople
whohavedevelopednephroticsyndrome,
limitingintakeofdietarysodium,oftenfrom
salt,anduidmayberecommendedtohelp
reduceedema. A dietlowinsaturatedfat
andcholesterolmayalsoberecommendedto
helpcontrolhyperlipidemia.
Points to Remember
Nephroticsyndromeincludesthe
following:
proteinurialargeamountsof
proteinintheurine
hyperlipidemiahigherthan
normalfatandcholesterollevels
intheblood
edema,orswelling,usuallyinthe
legs,feet,oranklesandlessoften
inthehandsorface
hypoalbuminialowlevelsalbu-
minintheblood
Primarycausesofnephroticsyn-
dromearediseasesthataffectonly
thekidneys,suchasfocalsegmental
glomerulosclerosis(FSGS). Sec-
ondarycausesofnephroticsyn-
dromearediseasesthataffectmany
partsofthebody,suchasdiabetes.
Inadditiontoproteinuria,hyperlip-
idemia,edema,andhypoalbumina,
peoplewithnephroticsyndrome
mayexperience
weightgain
fatigue
foamyurine
lossofappetite
Thelossofdifferentproteinsfrom
thebodycanleadtoavariety
ofcomplicationsinpeoplewith
nephroticsyndrome.
Treatingnephroticsyndrome
includesaddressingtheunderlying
causeandtakingstepstoreduce
highbloodpressure,edema,high
cholesterol,andtherisksofinfec-
tion. Treatmentusuallyincludes
medicationsandchangesindiet.
4 NephroticSyndrome in Adults







































































Hope through Research
Inrecentyears,researchershavelearned
muchaboutkidneydisease. TheNational
InstituteofDiabetesandDigestiveand
KidneyDiseases(NIDDK)sponsorsseveral
programsaimedatunderstandingglomeru-
lardiseasessuchasFSGSandmembranous
nephropathy,whichareprimarycausesof
nephroticsyndrome. TheNIDDKalsostud-
iesdiseasessuchaslupusanddiabetes,which
aresecondarycausesofnephroticsyndrome.
Findingtreatmentsfortheseunderlying
causeswillhelppreventnephroticsyndrome
orstopitsprogression.
Participants inclinicaltrialscanplay amore
activeroleintheirownhealthcare,gain
accesstonewresearchtreatmentsbefore
theyarewidelyavailable,andhelpothers
bycontributingtomedicalresearch. For
informationaboutcurrentstudies,visit
www.ClinicalTrials.gov.
For More Information
American Kidney Fund
6110ExecutiveBoulevard,Suite1010
Rockville,MD 20852
Phone: 18006388299
Internet: www.kidneyfund.org
National Heart, Lung, and Blood Institute
Health Information Center
P.O.Box30105
Bethesda,MD 208240105
Phone: 3015928573
TTY: 2406293255
Fax: 2406293246
Email: nhlbiinfo@nhlbi.nih.gov
Internet: www.nhlbi.nih.gov
National Kidney Foundation
30East33rdStreet
New York, NY 10016
Phone: 18006229010or2128892210
Fax: 2126899261
Internet: www.kidney.org
The NephCure Foundation
15 Waterloo Avenue
Berwyn, PA 19312
Phone: 18666374287or6105400186
Email: info@nephcure.org
Internet: www.nephcure.org
The Nephrotic Syndrome Study Network
(NEPTUNE)
UniversityofMichigan
206SimpsonMemorialInstitute
102Observatory
AnnArbor,MI 48109
Phone: 18779NEPTUNE
(18779637886)or7346155021
Fax: 7346156005
Email: NEPTUNE-Study@umich.edu
Internet: www.neptune-study.org
Acknowledgments
Publicationsproduced bytheClearinghouse
arecarefullyreviewedbybothNIDDKsci-
entistsandoutsideexperts. Thispublication
wasreviewed by PatrickGipson,M.D.,and
MatthiasKretzler,M.D.,bothoftheUniver-
sityofMichiganMedicalCenter.
You may alsond additional information about this
topic by visiting MedlinePlus at www.medlineplus.gov.
This publication may contain informationabout
medications. When prepared, this publication
included the most current information available.
For updatesor for questions about any medications,
contact the U.S. Food and Drug Administration toll-
free at 1888INFOFDA (18884636332) orvisit
www.fda.gov. Consult your health care provider for
more information.
5 NephroticSyndrome in Adults
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NIH Publication No. 124624
March 2012
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