Under normal circumstances, Proteins don’t leak in urine and are retained in body. Kidneys have small filters called Nephrons which prevent this leakage. Any defect in these filters / Nephrons can lead to protein leakage and hence Nephrotic Syndrome.

Due to protein leakage in urine, the blood protein levels fall down which leads to collection of water in body. This excess water is visible as swelling over eyes and other body parts.

It is most commonly seen in children between 2-10 years of age. However it is seen at all ages also including new-born to adults.

Nephrotic Syndrome is not related to food habits at all and there is no infection inside kidneys. This is because of mild misdirection of Immunity of body which directly affects our filters/nephrons in kidney and make them leak protein.

This condition has chances of repeating itself called as Relapse when protein leakage and swelling reoccurs. The course may continue like this till 8-12 years of age. In some children it may not occur and in some it may still continue for longer periods. Usually minor infections like flu or any fever of any origin anywhere in the body can restart protein leakage and swelling. Sometimes allergy of skin can also act as trigger. Sometimes without any external infections too the leakage can start on its own which is unpredictable.

There are a series of urine and blood tests which will be done for child and they can confirm the diagnosis.

This condition requires a very close partnership between parents and the doctor. The medicine of choice universally are oral steroids which are medicinal steroids of proven benefits. The duration is usually prolonged lasting for 4-5 months for first episode of Nephrotic Syndrome. The medicines needs to be given under care of Paediatric Nephrologist with close follow up.

The side effects of these medical steroids are minor and Temporary. Notable are increased chubbiness of child due to increase in body fat, increased hunger, increased activities of children, mild increase in body hairs . Long term usage for years can lead to short stature, cataract, hyperglycaemia, osteopenia etc. Parents are advised not to skip the dosage of steroids without discussing with their doctor else the benefits will be lesser.

Apart from steroids , there are other medications also which are used in Nephrotic Syndrome to minimise the usage of steroids. They belong to category of immuno-modulators and are used in frequently relapsing category of Nephrotic Syndrome.

As the leakage of protein leads to loss of valuable immune proteins, the child has higher risk of developing infections. Hence appearance of any fever, abdominal pain etc. must be brought to notice of your doctor for urgent medical attention. Sudden increase of swelling over short duration needs immediate medical attention and sometimes hospital admission.

If left untreated, it leads to uncontrolled water collection in the abdominal cavity , body tissues, Lungs and genitalia. This leads to lot of discomfort and eventually breathlessness. Also it can lead to disturbances of electrolytes like Sodium and lead to complications. Sometimes it can lead to increased clotting of blood in major blood vessels of brain and lungs and lead to life threatening complications.

When the child is on steroids there are certain set of vaccines which are very important and must be received by your child. Similarly there are certain vaccines which must be avoided which will be guided by your Paediatric Nephrologist.

During the phase of swelling, it is recommended to restrict added salt in diet. In general it is better to avoid high fat diet and continue with normal protein diet. Water restriction is also suggested in case of excessive swelling.

Most kids live healthy and active life once disease is under control. The most important predictors are : positive Response to steroids and few relapses. Children who stop responding to steroids usually have a turbulent course.

Most kids with nephrotic syndrome don’t require kidney biopsy. Only certain subset of kids who have multiple relapses , not responding to steroids or have deranged kidney functions may require it. It is a very safe procedure and can be done for babies as small as 2 months even. It gives valuable information about underlying kidney disease and helps to design appropriate and accurate treatment lines.