Nephrotic syndrome

Nephrotic syndrome in children is a rare illness. It occurs in 6 to 7 children out of 1 lakh children. Lot of research has been done & still going on, no single reason for this illness is identified. However it is certain that it is not due to any infections, food habits or something parents or doctors could have done to avoid it. In majority of cases there is just leakage of albumin/protein in the urine. It results in decrease protein in blood, which in turn allows extra fluid to be collected in the body resulting in swelling. Usually swelling is in the eyes more or so in the morning & it seems to settle down as child becomes active. It needs long term treatment may be for months in majority of cases. At present there are several ways to control this disease. Cure occurs naturally. This disease has tendency to improve as the child grows older.

Anyone claiming for a cure by any form of medications or any form of other therapy in just giving false hopes. Majority of children have absolute normal quality of life during childhood & later on. They should attend school regularly, participate in all the activities & should do everything what other children do at their age. It is rare to put any sort of restrictions on them.As said earlier majority of cases just have leakage of protein in urine. Kidneys are able to perform all other functions quite normally. They do not need dialysis or transplant as tends to happens in other kidney diseases. Parents should adopt a positive attitude. The child should be allowed to eat, play & do everything as other children do at their age. They just need monitoring by checking their morning urine and rarely need blood tests after initial investigations. They rarely need hospitalization. It necessary for parents to understand a few facts about this disease. It helps to treat your own child in a proper way & also avoid unnecessary worries & fears.

MONITORING :
All children need urine checking preferably daily with help of a labstix at home. These labstix are easily available & it takes only a few seconds to check urine. After child awakes up in the morning the first urine which child passes should be checked. The urine passed in the afternoon or evening if checked may give you false report. Labstix (Albustix) gives reading depending on change of colour. Trace or Negetive are normal. One plus or more are abnormal. Proper records & charting of urine testing is essential for future treatment. Remission is said to have been achieved if urine is negative or trace for 3 consecutive days. Relapse is defined as urine is being positive with albustix 2 + or more.for 3 consecutive days. It is helpful also to keep a record of weight of child. Preferably accurate weighing scales (electronic weighing scales giving jumps of 100 gms.) are helpful.

RELAPSES & REMISSIONS OF NEPHROTIC SYNDROME :
It is quite common to have relapse after initial treatment or even during the course of treatment of Nephrotic Syndrome. Relapse do not cause any damage to kidneys. Relapse tends to have more when child get usual coughs/colds or any other viral infections.

Remember relapses are very easy to diagnose, urine albumin with Albustix start recording one plus or more. This happens even before swelling appears. Occasionally relapses settle spontaneously without medication once infection starts improving. However it is important to keep in touch with your doctor during period of relapses.

TREATMENT OF RELAPSES OF NEPHROTIC SYNDROME:
Relapse means urine is showing 2 + or more for three consecutive days. DO NOT GET UPSET or PANICKY. Relapses donot cause any kidney damage. If you are checking urine regularly relapse is diagnosed even before the swelling appears. Usually relapse occur following viral infections such as cough, cold & diarheal infection.

Following steps to be followed :
Get in touch with your local doctor as infections are to be treated in the usual fashion.

If possible do daily weight (early morning) on a sensitive electronic scale with jumps of 100gms. Weight tends to go up by 5-7% before swelling appears.

Occasionally (in15-25%) once infection settles, protein in urine disappears spontaneously.

If there is no appreciable weight gain (i.e. less than 5%) or there is no swelling it is reasonable to wait for 14 days. Whatever dose of steriods is being given should be continued.

Let your doctor decide when to treat relapse. Usually steroids are (Prednisolone / Wysolone) given in the dose of 2mg per kg. (weight of child) ON DAILY BASIS. Some doctor choose to use less dose. In that case close supervision by the treating doctor is essential.

Once the urine is negative or trace, for 3 consecutive days (minimum for 14 days of daily steriods ), steriods are given on alternate days & dose is gradually reduced.

If relapses occur frequently i.e. daily doses of steroids are needed more than 3 times in 6 months, other medicines are available to reduce the frequency of relapses.

MEDICINES - STEROIDS - SIDE EFFECTS :

There are several drugs available to treat Nephrotic Syndrome, however steroids (Prednisolone or Wysolone) remains the most important medicine.The other drugs have to be used depending on the clinical situation at a proper stage of treatment. It is true that steroid do have side effects, but it usually occurs if they are not given in a controlled way i.e. proper dose for required period is not given.Usually it is easy to predict when serious side effects are going to happen , so that other drugs can be used even before side effects have occurred.Majority of children with Nephrotic Syndrome do not get significant side effects due to steriods taken as they are given under close supervision of a qualified medical professional who has the depth knowledge of Nephrotic Syndrome. The other drugs are used so as to use less doses of steriods or to prolong the period of remission.

DIET :
As most of times they will need steroids, they have the tendency to gain weight. Sensible dietary habits which are applicable to all the healthy family members should be followed. Avoid high calorie food like ghee, butter chocolates, fried food on a daily basis. Semiskimmed milk should be used, avoid adding extra salt on food such as salad, fruits (Diet with normal salt is allowed). While on steroids they have tendency to eat more hence extra food in form of salad, fresh fruits should be encouraged. As such there is no food which is forbidden. Taste of the child, psychological impact & mood of children are more important. They should not be given the feeling at anytime that they have any restrictions due to Nephrotic Syndrome. All the activities including cycling, swimming should be encouraged.

MISCELLANEOUS:
Child can be given all usual medicine by any qualified doctor. There is no restriction. Immunization to be given after discussion with you doctor. It is important to keep in touch with your doctor if your child has relapse, fever, persistent abdominal pain, swelling, has got in contact with another child with chicken pox, measles, or if you have any doubt.

 

                                                

 

Nephrotic syndrome in a boy at young age on steroids, after on cured, happily married with two healthy children.

Majority of nephrotic children have normal life despite needing treatment for long period.

 

"BE POSITIVE" IS THE MOST IMPORTANT MESSAGE.

KEEP IN TOUCH WITH YOUR DOCTOR DURING RELAPSE, IF IN DOUBT RING YOUR DOCTOR.

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