Urological Health Chronic Kidney Disease What Is Nephrotic Syndrome? Indication of kidney disease By Veeraish Chauhan, MD Updated on November 28, 2023 Medically reviewed by Matthew Wosnitzer, MD Fact checked by Nick Blackmer Print Sciepro/Science Photo Library/Getty Images Table of Contents View All Table of Contents Signs and Symptoms Causes Diagnosis Complications Treatment Nephrotic syndrome is a combination of symptoms that indicate the kidneys aren’t working properly and can be seen in kidney disease. It is, therefore, a clinical diagnosis and not a disease by itself. This article explores the signs and symptoms and how it’s diagnosed and treated. Signs and Symptoms Nephrotic syndrome can be seen in a variety of conditions that lead to it. The combination of abnormalities that are grouped together under the umbrella term nephrotic syndrome include: Severe proteinuria, or excretion of an abnormally high level of protein in the urine Low protein level in the blood Edema, or swelling in the body High cholesterol and other lipids (fats) levels in the blood Tendency to form blood clots What Causes Nephrotic Syndrome? Typically the kidneys’ filters (the glomeruli) only allow waste products out from the blood into the urine. They hold back bigger molecules like protein particles found in the blood, one of which is albumin. In nephrotic syndrome, the glomeruli lose their ability to discriminate between the substances that pass through the kidney. Larger molecules begin to leak out into the urine, meaning “good stuff” passes out into the urine right along with waste products. This sets off a cascade of events that lead to full-fledged nephrotic syndrome. These alterations can occur on their own, with no apparent explanation, but are most commonly due to diseases or exposures that cause damage to the glomerulus. Diseases Kidney diseases such as focal segmental glomerulosclerosis that causes scarring of the glomeruli, are the most common causes of nephrotic syndrome. Other types of diseases can also cause alterations leading to nephrotic syndrome. These include: Diabetes mellitus Autoimmune diseases like lupus, in which the immune system malfunctions and attacks its own tissues and organs Infections such as HIV, hepatitis B, and hepatitis C Genetic disorders that affect the kidneys Exposures Nephrotic syndrome can also be caused by: Medications such as bisphosphonates (used to treat osteoporosis, a thinning and weakening of bones) and nonsteroidal anti-inflammatory drugs (NSAIDs) often taken for pain Environmental toxins Causes and Risk Factors of Chronic Kidney Disease Diagnosis Usually, the suspicion of nephrotic syndrome is set off by unexplained swelling around the eyes or in the ankles. Investigations for this would often include urine testing. This would then reveal an abnormally high level of protein in the urine. Sometimes patients with severely elevated protein in the urine will complain of seeing foam or suds in urine. Other abnormalities like low protein levels in the blood or high cholesterol levels may also be noted on blood tests. These tests will not necessarily identify the cause of nephrotic syndrome. If the cause is not apparent when reviewing someone’s medical history, a kidney biopsy will often need to be done. This is a procedure that involves taking a small sample of tissue from the kidney and examining it in a lab. Understanding Kidney Function Tests Complications Nephrotic syndrome due to certain diseases may actually resolve on its own. However, uncorrected nephrotic syndrome can have harmful consequences. Progressive worsening of the kidneys’ function and their ability to filter waste products and excess fluid from the body Increased risk of heart disease A higher risk of blood clots, deep vein thrombosis (a blood clot in a large vein), or pulmonary embolism (blood clot in the main blood vessel leading to the lungs) Increased risk of infection due to the loss of protective antibodies that help fight diseases via the urine Treatment This is a condition that is best treated by seeking the advice of a nephrologist, a physician who specializes in kidney diseases. Treatment varies based on the cause, symptoms, and level of kidney damage. Once these factors are determined, treatment might include a combination of the following medications: Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) to help reduce protein loss and lower blood pressure A diuretic (water pill) like furosemide to reduce swelling Statins to lower cholesterol The success of treatment also depends on the cause. Certain concerns are more likely to be responsive to treatment, while others will not even respond to the best options available. Treatment for any complications may accompany the above. For example, blood thinners may be required for some patients to prevent blood clots. A low-sodium diet is almost always necessary to control swelling. Summary Nephrotic syndrome is a combination of symptoms that indicate the kidneys aren’t working properly. It has many causes but is most often caused by kidney diseases. It is typically diagnosed based on symptoms, medical history, and urine tests. 8 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Institute of Diabetes and Digestive and Kidney Diseases. Nephrotic syndrome in adults. BMJ Best Practice. Evaluation of nephrotic syndrome. Graca A, Suszek D, Jeleniewicz R, Majdan M. Nephrotic syndrome in the course of type 1 diabetes mellitus and systemic lupus erythematosus with secondary antiphospholipid syndrome – diagnostic and therapeutic problems. A case-based review. Reumatologia. 2020;58(5):331–334. doi:10.5114/reum.2020.100105 Sales GTM, Foresto RD. Drug-induced nephrotoxicity. Rev Assoc Med Bras. 2020;66(suppl 1):s82-s90. doi:10.1590/1806-9282.66.S1.82 Lin SY, Hsu WH, Lin CL, et al. Association of exposure to fine-particulate air pollution and acidic gases with incidence of nephrotic syndrome. Int J Environ Res Public Health. 2018;15(12):2860. doi:10.3390/ijerph15122860 Wada T, Ishimoto T, Nakaya I, et al. A digest of the evidence-based clinical practice guideline for nephrotic syndrome 2020. Clin Exp Nephrol. 2021;25(12):1277-1285. doi:10.1007/s10157-021-02098-5 Kelddal S, Nykjær KM, Gregersen JW, Birn H. Prophylactic anticoagulation in nephrotic syndrome prevents thromboembolic complications. BMC Nephrol. 2019;20(1):139. doi:10.1186/s12882-019-1336-8 Gupta S, Pepper RJ, Ashman N, Walsh SB. Nephrotic syndrome: oedema formation and its treatment with diuretics. Front Physiol. 2019;9:1868. doi:10.3389/fphys.2018.01868 By Veeraish Chauhan, MD Veeraish Chauhan, MD, FACP, FASN, is a board-certified nephrologist who treats patients with kidney diseases and related conditions. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? 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