What Is Nephrotic Syndrome
Nephrotic syndrome is not a single disease – it is a syndrome. A syndrome is a set of symptoms and signs that tend to occur together and which can be caused by one or more different diseases. Nephrotic syndrome can be caused by many different diseases, some more serious than others.
The main feature of nephrotic syndrome is that the kidneys leak a lot of protein. Normally, urine contains virtually no protein. In nephrotic syndrome the urine contains large amounts of protein. What happens is that filters in the kidneys become ‘leaky’ and protein, instead of remaining in the blood, leaks out into the urine. Protein in the urine is called proteinuria.
The other key features of nephrotic syndrome are:
Other typical symptoms and signs of nephrotic syndrome are discussed later.
Testing For Protein In Urine
The only way to diagnose proteinuria is through a urine test, which measures the amount of protein in your urine.
The test takes place in a doctors office. During the procedure, you urinate into a specimen cup. The doctor places a dipstick, or a small plastic stick coated with chemicals, into the urine sample. If it has too much protein, the stick will change color.
The rest of the urine will be sent to a lab, where it will be examined under a microscope.
If the doctor thinks you have kidney concerns, theyll repeat the urine test three times in 3 months. This helps them rule out temporary causes of proteinuria.
A doctor might also use the following tests to determine whats causing your proteinuria:
- 24-hour urine protein test. In this test, the doctor collects multiple urine samples over 1 day and sends them to a lab.
What Happens If You Have Proteinuria
Protein gets into your pee if your kidneys arent working correctly.
Glomeruli are groups of tiny blood vessels in your kidneys. They perform the first stage of filtering waste products and excess water from your blood. The waste products and excess water leave your body through your pee. Glomeruli dont allow passage of larger proteins or blood cells into your pee. If smaller proteins sneak through your glomeruli, then long, thin tubes in your kidneys recover the proteins and keep them in your body.
Proteins may flow into your pee if theres:
- Damage to your glomeruli or tubules.
- A problem with the reabsorption process of the proteins.
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Treatment Of High Blood Pressure
Many people with kidney disorders have high blood pressure. This is because the kidney makes chemicals involved in the control of blood pressure. If you develop high blood pressure then treatment is usually advised to bring your blood pressure down. A medicine called an angiotensin-converting enzyme inhibitor or an angiotensin-II receptor antagonist – sometimes called an angiotensin receptor blocker – is commonly used for this. These medicines seem to have a protective effect on the kidneys and can reduce the amount of protein leaking. These medicines might not be suitable for everyone but your doctor can advise you whether you need to take them. In very rare circumstances they can make your kidney function worse .
What Causes Protein In The Urine
Healthy kidneys remove extra fluid and waste from your blood and transform it into urine. Healthy kidneys do not remove proteins and other important nutrients, which pass through and return to your blood. But when your kidneys are damaged, they may let this protein leak into your urine. This causes high levels of protein in your urine.
Anyone can have protein in their urine. You may be more likely to have protein in your urine if you have one or more of the risk factors for kidney disease. There are health problems that can cause long-lasting protein in the urine, and some that can cause short-term protein in the urine.
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Can I Get More Help To Manage My Diabetes
Yes, a diabetes educator can teach you how to control your blood sugar. Your doctor can help you find a diabetes educator in your area. To find a diabetes education program in your area, you can use the American Association of Diabetes Educators online locator. Medicare and many private insurance plans will help pay for visits with a diabetes educator.
What Are The Symptoms Of Protein In Urine
When a person first begins to have kidney problems, they may not notice any symptoms. This is why a urine test can be essential to detect protein in the urine, which may indicate early signs of kidney disease.
In addition to proteinuria, symptoms of kidney disease can include:
- Foamy or frothy urine
- Trouble concentrating
If you are pregnant, protein in urine can also be a sign of preeclampsia, a very dangerous condition that can cause high blood pressure and lead to hospitalization. Additional signs of preeclampsia can include headaches, vision changes, abdominal pain, nausea, decreased urine output, and shortness of breath.
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Who Is At Risk For Nephrotic Syndrome
Anyone can get nephrotic syndrome, but it is slightly more common in men than in women. In children, it happens most often between the ages of two and six. There are other factors that may increase your risk.You are more likely to get nephrotic syndrome if you:
- Have a disease that affects the kidneys such as FSGS, lupus or diabetes
- Take certain medicines like nonsteroidal anti-inflammatory drugs or antibiotics
- Have an infection such as HIV, hepatitis B and C or malaria
How Can I Prevent Ckd
If you have diabetes or high blood pressure, the best way to prevent CKD is to work with your doctor to control your blood sugar and blood pressure. Diabetes and high blood pressure are the two most common causes of CKD.
Other ways to help protect your kidneys are to:
- Make healthy choices, such as eating healthy foods and being active.
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Possible Complications From Nephrotic Syndrome Itself
Complications can be caused by nephrotic syndrome itself due to the loss of normal proteins from the blood. These include:
- An increased risk of developing infections. This is because you can lose antibodies in the urine. Any signs of infection , etc) should be taken seriously and reported promptly to a doctor.
- An increased risk of developing blood clots in the blood vessels . For example, a deep vein thrombosis in a leg. This can cause pain, swelling and other complications. The reason for this is because there can be a change in the balance of proteins in the blood that protect against blood clots forming.
- A high cholesterol level. If this persists long-term it is a risk factor for developing heart disease.
- Increased risk of vitamin D deficiency which may lead to bone problems. This is due to loss of vitamin D-binding protein from the bloodstream.
- Anaemia. This is due to loss of proteins that help to carry iron around in the bloodstream. You need iron to make red blood cells and to prevent anaemia.
- Acute kidney injury. This may rarely occur from the nephrotic syndrome itself, or more commonly due to complications such as infections, or as an unintended result of treatment.
Depending on the duration and severity of the nephrotic syndrome, you may be advised to take treatment to help prevent or reduce the risk of these possible complications.
How Often Do I Need To Have A Test For Albuminuria
People who are at increased risk for kidney disease should have this test as part of routine checkups by a healthcare provider. Those at increased risk include:
People with diabetes
People with high blood pressure
People with a family history of kidney failure
People who are 65 years or older
Certain ethnic groups including African Americans, Hispanics, Asians, American Indians
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Kidney Numbers And Ckd Heat Map
Watch a series of short, animated videos that will help you learn about the importance of knowing your kidney numbers, how the heat map works for identifying where you are in terms of kidney health and along with some tips for improving your kidney numbers and moving in the right direction on the heat map.
When Should I See My Healthcare Provider
Contact your healthcare provider if:
- You pee more frequently than you usually do, or it hurts to pee.
- Your pee is foamy or bubbly.
- You feel nauseous or vomit.
- You feel dizzy, weak or lightheaded.
- You have any swelling or puffiness around your face, abdomen or lower body.
- Your symptoms dont improve after treatment.
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How Does Protein Leak Out Into The Urine
The kidney’s filter, called the glomerulus is usually very selective. It lets the bad toxins out into the urine. But it holds back the good stuff . However, damage to the kidneys filter can make it lose this selectivity making protein escape. Other factors that can cause this is damage to the kidney’s drainage system or in rarer cases, an excess amount of protein in the blood where it just overflows into the urine.
Can Kidney Disease Cause Diabetes
Recent research has found that kidney disease may cause high blood sugar and diabetes. When you have kidney disease, your kidneys cannot filter waste products from your blood as well as they should. This can cause diabetes because high blood levels of the waste product urea can prevent your pancreas from making insulin the way it should. Urea is a waste product that your body makes after it breaks down protein.
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What Are The Signs And Symptoms Of Proteinuria
You may not have any symptoms in the early stages of proteinuria. In advanced stages of proteinuria, symptoms may include:
- Swelling in your face, belly, feet or ankles.
- More frequent urination.
- Congestive heart failure.
What level of proteinuria is concerning?
A normal amount of protein in your pee is less than 150 milligrams per day. If you have more than 150 milligrams of protein in your pee per day, you have proteinuria. The upper limit of normal can vary a bit between laboratories.
If you have 3 to 3.5 grams of protein in your pee per day, you have nephrotic-range proteinuria. Nephrotic syndrome is a relatively rare condition that causes your kidneys to release an excessive amount of protein in your pee.
How Do Doctors Treat Diabetes
The goal of treatment is to control your blood sugar and keep it in a healthy range. Doctors treat diabetes with medicines and a diabetes eating plan:
- For type 1 diabetes, insulin shots are the main treatment. They replace the hormone your body is not able to make.
- For type 2 diabetes, doctors use different medicines. These medicines work to lower your blood sugar. Sometimes is it possible to reverse type 2 diabetes by losing weight.
- For both types, to control your blood sugar, doctors and dietitians help you create and follow a diabetes eating plan and be active.
To know if your treatment is working, you will need to have tests to check your blood sugar often.
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Who Should Be Tested For Protein In The Urine
If you are part of a group that is considered high risk for kidney disease, your doctor will test your urine for protein as part of your regular preventative care. People who are at risk for kidney disease include:
- Those who are 65 or older.
- Those who have a family history of kidney disease.
- Those who have high blood pressure or diabetes.
- Members of certain ethnic groups, including Hispanics, Native Americans, Asians and African Americans.
How Is Protein In Urine Diagnosed
Testing for protein in urine is typically done via a test called a urinalysis. This simple urine test can detect protein levels in the urine and can be conducted in a doctors office. After your urine sample is collected, it is tested with a dipstick. When your urine has large amounts of protein, the strip of paper will change color. Technicians may also examine the sample via microscope.
If a urinalysis detects protein in the urine, your doctor will likely order an additional urine test or tests to determine if you have kidney disease. Your doctor may also conduct blood tests to measure your glomerular filtration rate , which can tell them how well your kidneys are filtering out waste, as well as other blood tests if needed to help identify the cause of the proteinuria. Additional tests may include an ultrasound, CT scan, or kidney biopsy.
When your urine is tested for protein, the test compares the amounts of albumin and creatinine, an amino acid, in your urine. A urine albumin-to-creatinine ratio higher than 30 milligrams per gram observed more than twice over a three-month period may indicate kidney disease.
If you get an abnormal result that detects protein in the urine, your doctor will also probably want to check your cholesterol levels, blood sugar, and blood pressure to determine what conditions might be contributing to proteinuria.
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How Can I Prevent Diabetes From Causing Kidney Disease
Work with your doctor to create a plan to prevent or slow damage to your kidneys. Even if your kidneys are already damaged, you can slow the damage from getting worse. Your plan may include to:
- Work with your doctor to control your blood sugar. Tell your doctor if your blood sugar is often too high or too low.
- Work with your doctor to control your blood pressure. Having both diabetes and high blood pressure can make you more likely to get kidney disease.
- Work with your doctor to manage your cholesterol. Cholesterol is a waxy, fat-like substance in your blood. Having both diabetes and high cholesterol can make you more likely to get kidney disease. High cholesterol can also make your diabetic kidney disease get worse faster. Ask your doctor what your cholesterol level should be and how you can control it.
- Take all of your prescription medicines as your doctor tells you.
- Meet with a diabetes educator or dietitian to help you create and follow an eating plan.
- Quit smoking or using tobacco.
- Be active at least 30 minutes a day on most days of the week. Being active helps your body use insulin better.
- Stay at a healthy weight. Ask your doctor what a healthy weight is for you.
How Does Protein Get Into The Urine
If the kidneys arent filtering blood properly, it may cause the protein to enter in urine. The kidneys glomeruli are responsible for filtering waste materials and cell debris from the blood.
Glomeruli of the kidney do not allow larger protein molecules to pass into the urine. Smaller proteins that evade the glomeruli are recaptured and retained in the body by tubules. Tubules are long, thin, hollow tubes found in the kidneys.
However, proteins can enter the urine if the glomeruli or tubules of the kidney are destroyed. If there is a problem with the reabsorption process of the proteins, it can cause Proteinuria.
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How Do You Treat Proteinuria
Proteinuria treatment depends on its cause. Each cause requires different treatments.
If kidney disease causes proteinuria, your treatment plan may include medication, diet changes and exercise. Your healthcare provider may prescribe blood pressure medication if you have high blood pressure. If you have low blood pressure, you should schedule annual urine tests and blood pressure checks.
If you have diabetes, you may need to control your blood sugar. You should also receive GFR blood tests every year.
Pregnant people with a history of preeclampsia should schedule regular checkups with their healthcare provider. Though preeclampsia is a serious condition, it typically goes away days to weeks after your baby is born.
If you have proteinuria but dont have diabetes, high blood pressure or any other medical condition, your healthcare provider may prescribe blood pressure medication to help prevent kidney damage. Its a good idea to have your blood pressure checked and urine tested every six months to ensure you dont have kidney disease.
If you have mild or temporary proteinuria, you may not need treatment.
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Diabetes and hypertension are the top causes of kidney disease, so if you have these conditions, your treatment will include getting these under control. For diabetics, this can include managing blood sugar, taking medication, eating healthy, and exercising.
For people with hypertension, doctors may recommend medication as well as diet and lifestyle changes. People with hypertension and proteinuria are also advised that they should keep their blood pressure below 130/80 millimeters of mercury .
People with diabetes and kidney disease or hypertension and kidney disease are often prescribed medications, including angiotensin-converting enzyme inhibitors or angiotensin receptor blockers . These medications may also be prescribed to people with kidney disease who do not have diabetes or hypertension.
If kidney damage is permanent, patients may also require dialysis or a kidney transplant.
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Detecting And Quantifying Proteinuria
The results are graded as negative , trace , 1+ , 2+ , 3+ or 4+ . This method preferentially detects albumin and is less sensitive to globulins or parts of globulins .12
The sulfosalicylic acid turbidity test qualitatively screens for proteinuria. The advantage of this easily performed test is its greater sensitivity for proteins such as Bence Jones. The SSA method requires a few milliliters of freshly voided, centrifuged urine. An equal amount of 3 percent SSA is added to that specimen. Turbidity will result from protein concentrations as low as 4 mg per dL . False-positive results can occur when a patient is taking penicillin or sulfonamides and within three days after the administration of radiographic dyes. A false-negative result occurs with highly buffered alkaline urine or a dilute specimen.