What is Nephrotic Syndrome

Male1: Sometimes, you go to a pediatrician and the kid’s eyes are a little bit puffy and he is doing—you say, wait a minute, the eyes are puffy, why is he doing it here, and he notices there is punching in ear and he said he will get it to you. Everybody thought I had an eye problem, he looks at you and you see the kid. This does not make any sense to me, can you make some sense out of this? Male2: I will try. The question is why the child swelling around the eyes. The mother may think it is some eye problem or could be an allergy, however, this is a sign of swelling, what we call edema and when we have edema, the kidneys could be responsible. To make the long story short, the kidney filters the blood, but it does not allow the protein to go into the urine. If there is protein in the urine or a huge amount of protein in the urine, that means that the kidney has a problem. The kidney cannot keep the protein, the kidney goes—the protein goes into the urine, the protein in the blood goes low. When the protein in the blood goes low, that causes swelling everywhere. The first place or the place where you notice this is around the eyes, so when you see a child that has swelling around the eyes, think that this could be a kidney problem that the kidney maybe losing protein and that is what we need to address. Male1: Are there any other areas that if you go look for the swelling, it would also be indicative of this? Male2: The swelling can happen in many different areas, but you can notice it on the legs and on the feet, the lower extremities, you can see some distention of the abdomen, the fluid can accumulate in the abdomen and sometimes you can have it in the back as well, so everywhere. Obviously, if it is very severe, it can also cause swelling of the scrotum, swelling of the genital area in females and also can accumulate inside the body. Obviously, you cannot see that, but the fluid can accumulate everywhere. Male1: What is the term for this, what is that term called? When the kids have this kind of condition, when they get swelling in the eyes? Male2: When we have swelling of everywhere, we call it nephrotic syndrome. Male1: Is that a common disease? Male2: It is not a common disease, but we have to be aware of it. As nephrologists, it is common for us. It is not as common for a general pediatrician, but a pediatrician should be aware that a child with the orbital swelling, they should think first of the kidney because that is an important disease and you need to address it and you need to treat it. Male1: It can be treated, how do we treat that? Male2: The treatment of these nephrotic syndrome, usually we give them medication. Male1: Are there any particular hallmark of medicine? Male2: We use steroids, we use prednisone. Male1: And that is a good thing because it can stop this process? Male2: Prednisone in the majority of children, there are different—nephrotic syndrome is a huge term with many causes, but the most common in children and this happens in children starting at age two to age three, age four and age five, they get this nephrotic syndrome where prednisone works very well, stops the protein in the urine, if there is no protein in the protein, the protein in the blood goes up again. Puts the system in balance again and the swelling around the eyes and the swelling all around the body disappears and gets better. Male1: This is a life-long problem or a temporary problem? Male2: It is interesting. It is a good question. In the majority of children, it is not a life-long problem, but it is not a self limited, quick problem. It is not temperate. It may take a while. It may take months, it may take years to resolve. In other words, you treat it and it gets better, but a couple of months of later, that can happen again and it is important for the parent to know that this is a recurrent problem that over time, over the years, it will get better. Usually, it gets better, but it may take a couple of years. Male1: Because you use so much prednisone with this, pediatricians have a problem now, you cannot quite give live vaccines like measles and chicken pox, the kid is in big doses of prednisone, so you have to start to lay that a little bit, do we not? Male2: That is correct. Male1: The other vaccines probably are okay, is that correct? Male2: Yes, but we have to wait, I mean— Male1: So we have to wait until the kids are at a remit stage off the prednisone for a month or so or whatever it is and try to get the vaccine in.