Question: What is (are) Childhood Nephrotic Syndrome ?
Answer: Childhood nephrotic syndrome is not a disease in itself; rather, it is a group of symptoms that - indicate kidney damageparticularly damage to the glomeruli, the tiny units within the kidney where blood is filtered - result in the release of too much protein from the body into the urine When the kidneys are damaged, the protein albumin, normally found in the blood, will leak into the urine. Proteins are large, complex molecules that perform a number of important functions in the body. The two types of childhood nephrotic syndrome are - primarythe most common type of childhood nephrotic syndrome, which begins in the kidneys and affects only the kidneys - secondarythe syndrome is caused by other diseases A health care provider may refer a child with nephrotic syndrome to a nephrologista doctor who specializes in treating kidney disease. A child should see a pediatric nephrologist, who has special training to take care of kidney problems in children, if possible. However, in many parts of the country, pediatric nephrologists are in short supply, so the child may need to travel. If traveling is not possible, some nephrologists who treat adults can also treat children.
Source: NIDDK

Question: What is (are) Childhood Nephrotic Syndrome ?
Answer: The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. Children produce less urine than adults and the amount produced depends on their age. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. Kidneys work at the microscopic level. The kidney is not one large filter. Each kidney is made up of about a million filtering units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a two-step process. The glomerulus lets fluid and waste products pass through it; however, it prevents blood cells and large molecules, mostly proteins, from passing. The filtered fluid then passes through the tubule, which sends needed minerals back to the bloodstream and removes wastes.
Source: NIDDK

Question: What are the complications of Childhood Nephrotic Syndrome ?
Answer: The complications of childhood nephrotic syndrome may include - infection. When the kidneys are damaged, a child is more likely to develop infections because the body loses proteins that normally protect against infection. Health care providers will prescribe medications to treat infections. Children with childhood nephrotic syndrome should receive the pneumococcal vaccine and yearly flu shots to prevent those infections. Children should also receive age-appropriate vaccinations, although a health care provider may delay certain live vaccines while a child is taking certain medications. - blood clots. Blood clots can block the flow of blood and oxygen through a blood vessel anywhere in the body. A child is more likely to develop clots when he or she loses proteins through the urine. The health care provider will treat blood clots with blood-thinning medications. - high blood cholesterol. When albumin leaks into the urine, the albumin levels in the blood drop. The liver makes more albumin to make up for the low levels in the blood. At the same time, the liver makes more cholesterol. Sometimes children may need treatment with medications to lower blood cholesterol levels.
Source: NIDDK

Question: How to diagnose Childhood Nephrotic Syndrome ?
Answer: A health care provider diagnoses childhood nephrotic syndrome with - a medical and family history - a physical exam - urine tests - a blood test - ultrasound of the kidney - kidney biopsy Medical and Family History Taking a medical and family history is one of the first things a health care provider may do to help diagnose childhood nephrotic syndrome. Physical Exam A physical exam may help diagnose childhood nephrotic syndrome. During a physical exam, a health care provider most often - examines a childs body - taps on specific areas of the childs body Urine Tests A health care provider may order the following urine tests to help determine if a child has kidney damage from childhood nephrotic syndrome. Dipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine, which could mean kidney damage. The child or a caretaker collects a urine sample in a special container. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the childs urine sample. Patches on the dipstick change color when albumin is present in urine. Urine albumin-to-creatinine ratio. A health care provider uses this measurement to estimate the amount of albumin passed into the urine over a 24-hour period. The child provides a urine sample during an appointment with the health care provider. Creatinine is a waste product filtered in the kidneys and passed in the urine. A high urine albumin-to-creatinine ratio indicates that the kidneys are leaking large amounts of albumin into the urine. Blood Test A blood test involves drawing blood at a health care providers office or a commercial facility and sending the sample to a lab for analysis. The lab tests the sample to estimate how much blood the kidneys filter each minute, called the estimated glomerular filtration rate, or eGFR. The test results help the health care provider determine the amount of kidney damage. Health care providers may also order other blood tests to help determine the underlying disease that may be causing childhood nephrotic syndrome. Ultrasound of the Kidney Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care providers office, an outpatient center, or a hospital. A radiologista doctor who specializes in medical imaginginterprets the images to see if the kidneys look normal; a child does not need anesthesia. Kidney Biopsy Biopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. A health care provider performs the biopsy in an outpatient center or a hospital. The health care provider will give the child light sedation and local anesthetic; however, in some cases, the child will require general anesthesia. A pathologista doctor who specializes in diagnosing diseasesexamines the tissue in a lab. The test can help diagnose childhood nephrotic syndrome. When the health care provider suspects a child has minimal change disease, he or she often starts treatment with medications without performing a biopsy. If the medication is effective, the child does not need a biopsy. In most cases, a health care provider does not perform a biopsy on children younger than age 12 unless he or she thinks that another disease is the cause.
Source: NIDDK

Question: What are the treatments for Childhood Nephrotic Syndrome ?
Answer: Health care providers will decide how to treat childhood nephrotic syndrome based on the type: - primary childhood nephrotic syndrome: medications - secondary childhood nephrotic syndrome: treat the underlying illness or disease - congenital nephrotic syndrome: medications, surgery to remove one or both kidneys, and transplantation Primary Childhood Nephrotic Syndrome Health care providers treat idiopathic childhood nephrotic syndrome with several types of medications that control the immune system, remove extra fluid, and lower blood pressure. - Control the immune system. Corticosteroids are a group of medications that reduce the activity of the immune system, decrease the amount of albumin lost in the urine, and decrease swelling. Health care providers commonly use prednisone or a related corticosteroid to treat idiopathic childhood nephrotic syndrome. About 90 percent of children achieve remission with daily corticosteroids for 6 weeks and then a slightly smaller dose every other day for 6 weeks.2 Remission is a period when the child is symptom-free. Many children relapse after initial therapy, and health care providers treat them with a shorter course of corticosteroids until the disease goes into remission again. Children may have multiple relapses; however, they most often recover without long-term kidney damage. When a child has frequent relapses or does not respond to treatment, a health care provider may prescribe other medications that reduce the activity of the immune system. These medications prevent the body from making antibodies that can damage kidney tissues. They include - cyclophosphamide - mycophenolate (CellCept, Myfortic) - cyclosporine - tacrolimus (Hecoria, Prograf) A health care provider may use these other immune system medications with corticosteroids or in place of corticosteroids. - Remove extra fluid. A health care provider may prescribe a diuretic, a medication that helps the kidneys remove extra fluid from the blood. Removing the extra fluid can often help to lower blood pressure. - Lower blood pressure. Some children with childhood nephrotic syndrome develop high blood pressure and may need to take additional medications to lower their blood pressure. Two types of blood pressure-lowering medications, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have the additional benefit of slowing the progression of kidney disease. Many children with nephrotic syndrome require two or more medications to control their blood pressure. Secondary Childhood Nephrotic Syndrome Health care providers treat secondary childhood nephrotic syndrome by treating the underlying cause of the primary illness. For example, a health care provider may treat children by - prescribing antibiotics for an infection - adjusting medications to treat lupus, HIV, or diabetes - changing or stopping medications that are known to cause secondary childhood nephrotic syndrome While treating the underlying cause, the health care provider will also treat the child to improve or restore kidney function with the same medications used to treat primary childhood nephrotic syndrome. Caretakers should make sure that children take all prescribed medications and follow the treatment plan recommended by their health care provider. More information about specific treatments for secondary childhood nephrotic syndrome is provided in the NIDDK health topic, Glomerular Diseases. Congenital Nephrotic Syndrome Researchers have found that medications are not effective in treating congenital nephrotic syndrome, and that most children will need a kidney transplant by the time they are 2 or 3 years old. A kidney transplant is surgery to place a healthy kidney from someone who has just died or a living donor, most often a family member, into a persons body to take over the job of the failing kidney. To keep the child healthy until the transplant, the health care provider may recommend the following: - albumin injections to make up for the albumin lost in urine - diuretics to help remove extra fluid that causes swelling - antibiotics to treat the first signs of infection - growth hormones to promote growth and help bones mature - removal of one or both kidneys to decrease the loss of albumin in the urine - dialysis to artificially filter wastes from the blood if the kidneys fail More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure in Children.
Source: NIDDK

Question: How to prevent Childhood Nephrotic Syndrome ?
Answer: Researchers have not found a way to prevent childhood nephrotic syndrome when the cause is idiopathic or congenital.
Source: NIDDK

Question: What to do for Childhood Nephrotic Syndrome ?
Answer: - Childhood nephrotic syndrome is not a disease in itself; rather, it is a group of symptoms that - indicate kidney damageparticularly damage to the glomeruli, the tiny units within the kidney where blood is filtered - result in the release of too much protein from the body into the urine - The two types of childhood nephrotic syndrome are - primarythe most common type of childhood nephrotic syndrome, which begins in the kidneys and affects only the kidneys - secondarythe syndrome is caused by other diseases - The signs and symptoms of childhood nephrotic syndrome may include - edemaswelling, most often in the legs, feet, or ankles and less often in the hands or face - albuminuriawhen a childs urine has high levels of albumin - hypoalbuminemiawhen a childs blood has low levels of albumin - hyperlipidemiawhen a childs blood cholesterol and fat levels are higher than normal - A health care provider may order urine tests to help determine if a child has kidney damage from childhood nephrotic syndrome. - Health care providers will decide how to treat childhood nephrotic syndrome based on the type: - primary childhood nephrotic syndrome: medications - secondary childhood nephrotic syndrome: treat the underlying illness or disease - congenital nephrotic syndrome: medications, surgery to remove one or both kidneys, or transplantation
Source: NIDDK