American Medical Association Family Medical Guide - American Medical Association [205]
Nephrotic Syndrome
Nephrotic syndrome is an uncommon disorder in which the glomeruli (the filtering units of the kidneys) are damaged, causing protein to leak out of the blood and into the urine. In nephrotic syndrome, the output of urine is significantly reduced, resulting in edema (abnormal accumulation of fluid in the body). About 80 percent of cases of nephrotic syndrome occur in children between ages 1 and 6, mostly ages 2 and 3. Boys are affected more often than girls.
A child with nephrotic syndrome is vulnerable to various infections, including peritonitis (see page 759), urinary tract infections (see page 426), and pneumonia (see page 660). In rare cases, nephrotic syndrome persists after treatment and develops into chronic glomerulonephritis (see page 807), which can lead to kidney failure (see page 817).
Symptoms
Edema is a major symptom of nephrotic syndrome. Over several weeks, the edema causes the child’s body to swell; the swelling is usually most noticeable in the face, abdomen, legs, ankles, and feet. The child also has a significant decrease in urine output. If your child has symptoms of nephrotic syndrome, see your doctor right away.
Diagnosis
A diagnosis of nephrotic syndrome is based on a child’s symptoms and the results of a physical examination. The doctor takes samples of your child’s urine and blood for laboratory analysis. If the test results suggest that your child may have nephrotic syndrome, the doctor will order additional urine and blood tests and, in some cases, a kidney biopsy (in which a small amount of kidney tissue is removed and examined under a microscope) to confirm the diagnosis.
Treatment
A child with nephrotic syndrome is usually hospitalized so treatment can be carefully monitored. He or she is placed on a low-sodium, high-protein diet and given medications such as diuretics (to decrease fluid) and corticosteroids (to reduce inflammation). In some cases, stronger medications such as chemotherapy drugs may be administered. The symptoms usually clear up after 2 weeks of treatment in the hospital, and the child can continue recovering at home.
At home, the child will need to take his or her medication exactly as prescribed and continue eating the special diet. Food should be cooked and served without salt, and the diet should contain plenty of protein—from foods such as fish, meat, eggs, and low-salt cheese—to help restore the body’s supply of protein. The doctor also may restrict the child’s intake of fluids to reduce edema.
In most cases, children recover completely with no lasting effects. In some cases, the disorder recurs after the child has been free of symptoms for several weeks or months, and treatment must be repeated. Occasionally the disorder continues to come and go, and the child needs prolonged treatment with corticosteroid medications to eliminate the condition. In rare cases, a child develops kidney failure and will need to have a kidney transplant (see page 820).
Renal Dysplasia
Renal dysplasia—also called dysplastic kidneys, multicystic kidneys, or cystic dysplastic renal disease—is a condition in which the cells and structures of the kidneys develop abnormally before birth. Usually only one kidney is affected, although both can be affected. The abnormal kidney may be either small or enlarged, with a number of irregular cysts. Renal dysplasia is one of the most common prenatal developmental abnormalities and is often detected before birth during a routine ultrasound scan. The disorder is not inherited.
Symptoms
The most common sign of renal dysplasia in a newborn is a noticeable mass in the baby’s abdomen. The infant may also develop a urinary tract infection, blood in the urine, and high blood pressure. If both kidneys are affected, infants sometimes die if they do not receive