Nephrotic syndrome


What should I do about vomiting in nephrotic syndrome?
Patients with nephrotic syndrome experience significant urinary protein, which actually indicates glomerular lesions. If the patient does not have severe renal failure, such symptoms often do not lead to vomiting. If vomiting occurs, it is necessary to identify the cause, whether there is widespread edema, including gastrointestinal edema leading to vomiting, or if there is severe renal failure, even acute renal failure. In these cases, the patient's vomiting may be related to the nephrotic condition. Additionally, some medications used to treat nephrotic syndrome might cause vomiting and should be discontinued. If the vomiting is related to renal conditions, it is crucial to actively treat the primary disease and control nephrotic syndrome. However, if none of the above reasons are applicable, there might be an issue with the gastrointestinal tract itself, requiring consultation in gastroenterology, possibly needing a gastroscopy, and the use of medications to suppress stomach acid and promote gastrointestinal motility. (Please use medications under the guidance of a doctor.)


What is good for children with nephrotic syndrome to eat?
Nephrotic syndrome is mainly due to increased permeability of the glomerular basement membrane, leading to a syndrome characterized by heavy proteinuria, hypoalbuminemia, hyperlipidemia, and severe edema. The dietary requirements for this disease include low salt, low fat, and high-quality protein diet. Therefore, it is best to use less salt in dishes, and also, one should not drink too much water, as excessive water intake can easily cause sodium and water retention. Additionally, too much sodium can also lead to sodium and water retention and the development of hypertension. Foods rich in fats, fatty meats, and seafood should be avoided, while high-quality proteins generally include lean meats, beef, milk, eggs, etc. Consumption of such high-quality proteins and soy products should be limited.


What should I do about the high fever caused by nephrotic syndrome?
Patients with nephrotic syndrome, due to long-term use of steroids, have particularly weak resistance and are prone to various infections. High fever is a common symptom in patients with nephrotic syndrome after an infection. Once a high fever due to infection occurs in nephrotic syndrome, it must be taken seriously because infections are often a significant trigger for the relapse or worsening of the condition. Once the condition worsens, patients often experience heavy proteinuria, hypoalbuminemia, edema, and declining kidney function. Therefore, it is crucial to go to the hospital in a timely manner after the onset of high fever for medical treatment, and to conduct routine blood and urine tests, kidney function tests, and chest X-rays to determine the cause of the patient's high fever, whether it is a viral or bacterial infection. Besides, it is important to drink plenty of water, urinate frequently, rest in bed, reduce outdoor activities, and avoid fatigue. If a viral infection causes the fever, antiviral medications that clear heat and detoxify should be used. If a bacterial infection causes the fever, sensitive antibiotics should be used for symptomatic treatment. (Medications should be used under the guidance of a doctor.)


Is pediatric nephrotic syndrome contagious?
Pediatric nephrotic syndrome is a clinical syndrome characterized by increased glomerular filtration membrane permeability due to various causes, leading to the loss of a large amount of protein from plasma through urine. Its main manifestations are: 1. Massive proteinuria, which is the most basic pathophysiological change in nephrotic syndrome and a necessary condition for diagnosis. 2. Hypoalbuminemia. 3. Hyperlipidemia. 4. Significant generalized edema. Nephrotic syndrome is not contagious, so pediatric nephrotic syndrome is not infectious. Contact with children with nephrotic syndrome will not result in contracting the syndrome, so parents can be assured on this matter.


Is nephrotic syndrome nauseating?
Nephrotic syndrome generally does not cause symptoms of nausea. Nephrotic syndrome refers to the damage to the glomerular capillaries of the patient, with the patient's 24-hour urinary protein quantification exceeding 3.5 grams, which indicates a substantial presence of urinary protein. This disease can cause edema in various parts of the body, such as the lower limbs, eyelids, and facial area. However, it generally does not cause digestive symptoms such as nausea and vomiting. If a patient exhibits such symptoms, it is necessary to be cautious as it may indicate the onset of acute renal failure due to nephrotic syndrome, or the presence of acute inflammation in the gastrointestinal tract. Patients with nephrotic syndrome generally may experience edema in the gastrointestinal tract, which could cause nausea, and it is important to be cautious of the possibility of other underlying causes.


How to maintain health with nephrotic syndrome
Patients with nephrotic syndrome should pay attention to maintenance because nephrotic syndrome is a chronic disease. Even if the condition is well controlled, it can still recur or worsen under certain circumstances. First and foremost, patients should avoid various inflammations, including infections of the upper respiratory tract, enteritis, skin infections, ulcers, etc. Patients should avoid getting cold, avoid contact with people who have colds, and wear masks in crowded places. Avoid eating raw, unhygienic food to prevent diarrhea and enteritis. Patients should also limit their salt intake, and it is recommended that their daily salt intake be controlled between 3 and 6 grams.


Nephrotic syndrome urine output
Patients with nephrotic syndrome vary in the amount of urine they produce. Some patients have normal urine output and may not exhibit obvious symptoms of edema, but others may have reduced urine output, which can even lead to acute renal failure. Nephrotic syndrome emphasizes that the glomerular filtration barrier is damaged, resulting in a large amount of urinary protein, with a 24-hour urinary protein quantitative exceeding 3.5 grams. This situation highlights the decreased ability of the filtration barrier to retain proteins in the blood, meaning the integrity of the filtration barrier is compromised. However, the kidney's ability to excrete water and metabolic waste is not indicated by the term "nephrotic syndrome" itself, thus the patient's urine output can vary.


Syndrome of kidney disease with manifestations of calcium deficiency
In the state of nephrotic syndrome, if there is a calcium deficiency, it may cause the patient's limbs to twitch, especially sudden twitches and pain in both lower limbs during sleep at night, waking the patient from sleep. If calcium deficiency persists for a long time, it may lead to osteoporosis in the patient, such as osteoporosis of the femoral head, which presents with hip pain, and necrosis of the femoral head, potentially affecting the patient's ability to walk. In children, calcium deficiency may cause night-time convulsions, and external manifestations such as hunchback, pigeon chest, and square skull might appear.


Do you take steroids for nephrotic syndrome?
Once nephrotic syndrome is diagnosed, corticosteroid therapy becomes a primary treatment, and the commonly used steroid is prednisone. If there is liver damage or the treatment effect of prednisone is not good, oral prednisolone or intravenous methylprednisolone can be used. Due to its long half-life and severe side effects, dexamethasone is now generally less used. The course of treatment with corticosteroids for nephrotic syndrome is relatively long, needing about one to one and a half years. During this process, the use of steroids has three phases: the initial full-dose phase, during which a relatively large dose of the hormone is used for about two to three months; the second phase is a slow reduction process; the third phase is a low-dose maintenance process. Overall, during the use of steroids, patients must regularly follow up at outpatient clinics, and adjust the steroids according to the doctor's advice. One must not arbitrarily reduce the dose or stop the medication, as this can easily lead to a relapse of nephrotic syndrome.


Conditions for discontinuing medication for nephrotic syndrome
The main clinical manifestations of nephrotic syndrome are significant proteinuria and hypoproteinemia, along with varying degrees of hyperlipidemia and edema. Nephrotic syndrome often requires treatment with corticosteroids. The general principle for using steroids is to start with a sufficient dosage and administer it slowly, maintaining it for a long duration, approximately around one year. Therefore, the conditions for discontinuing medication in nephrotic syndrome include: if the patient has been treated with steroids for about a year, and the proteinuria has resolved, 24-hour urinary protein quantification is normal, there is no edema, blood albumin levels have returned to normal, and kidney function is also normal, then discontinuation of steroid treatment can be considered. Of course, after stopping the medication, it is essential to regularly visit the hospital for monitoring of routine urine tests, kidney function, and blood pressure to prevent the recurrence of nephrotic syndrome due to infections or fatigue.