Dr. M.J. Bazos, Patient Handout
About Your Diagnosis
Each kidney is composed of 1 million fine filters to cleanse the blood of poisons. They are designed to keep the desired components in the bloodstream and to excrete the harmful substances. Sometimes there is “leakiness” of the filter leading to the loss of proteins from the blood. The loss of these proteins can result in swelling (edema), seen initially in the ankles and face. This entity is termed nephritic syndrome. There are a variety of kidney problems that can lead to nephrotic syndrome: the most common are primary inflammatory states of the kidney (called glomerulonephritis), and there are other diseases
that can damage the kidney as a consequence. The condition is not transmissible. Nephrotic syndrome is seen frequently in kidney practice, although it is unusual in a general practice. It can vary in severity from patient to patient. Typically, most patients see their physician because of swollen ankles/legs, or even a swollen face observed at first rising in the morning. The doctor finds protein in the urine on testing. Subsequent blood tests will confirm the diagnosis of nephritic syndrome. In order for a cause to be diagnosed, to direct therapy, you may see a nephrologist for a biopsy. This is where the physician takes a small piece of kidney tissue with a special needle (no surgery usually needed). All patients with nephrotic syndrome will have a tendency to high cholesterol levels in the blood. Some patients have a progressive loss in kidney function after developing this condition.
Living With Your Diagnosis
Nephrotic syndrome is a painless condition under most circumstances. Patients may gain massive amounts of water weight, to their distress and discomfort. Pain may be a sign of an underlying new infection, a clot in the leg or pelvis (especially if accompanied by redness and local tenderness), or inflammation in the abdomen. There will be a tendency to hold on to the water and salt that you take with your diet; hence the need for diet modification. You will have a high cholesterol level that might require medications to help improve it, in addition to the dietary recommendations your doctor will suggest.
Initially, the doctor will begin “water pills” (diuretics) to remove excess water (e.g., furosemide [Lasix]). Occasionally you might need to rest in hospital so the Lasix can be given by vein to be more effective. It is ideal to weigh yourself daily to see how successful the diuretic therapy is. There are additional and alternative diuretics that may be used, depending on the severity of the nephritic edema and its responsiveness. Depending on your biopsy results, you might be offered treatment with powerful drugs against inflammation: prednisone, cyclophosphamide, or chlorambucil, for example. Your doctor will want you to remain as active as possible because nephrotic syndrome is associated with an increased tendency to develop clots in the legs.
There are side effects seen with these drugs. Lasix can cause a rash, low blood pressure, and low potassium and magnesium levels (these will be monitored closely by your physician). Prednisone can lead to hypertension, high blood glucose, stomach irritation, osteoporosis, and changes in the skin, to name a few (your physician can counsel you on the remainder of effects).
The DOs
• Do stay out of bed and mobile to encourage fluid loss and discourage clots.
• Do take the diuretic pills as often as they are prescribed. They may prove less effective because of poor absorption from the gut, so large doses might be needed.
• Do take the dietary and fluid intake to heart: the purpose of the therapy is to reduce the amount of salt and water in your system.
• Do avoid foods rich in cholesterol.
• Do eat plenty of calories to help keep your strength up while the treatment is underway.
• Do weigh yourself daily and keep a log to map your progress and halt a decline.
The DON’Ts
• Don’t become sedentary.
• Don’t smoke.
• Don’t take over-the-counter pills (especially nonsteroidal drugs like ibuprofen or Naproxen) that will confound the medical management of nephritic syndrome.
• Don’t forget the diet and fluid restrictions to help you get better faster.
• Don’t forget your medicines. Call the physician if there is a problem taking them.
• Don’t forget to weigh yourself to monitor progress.
When to Call Your Doctor
Call your physician if you have shortness of breath, or pain in the chest, abdomen, or legs. Call if you have fevers or chills. Record your weights and let your doctor know how the treatment is going. Always tell your doctor if you have problems with the therapy. A simple, timely explanation may go a long way to reassure you and your family members.