Nephrotic Syndrome: Symptoms, Types & Treatment in Bathinda

What is Nephrotic Syndrome?

Nephrotic syndrome is a clinical condition characterized by four key features: massive protein loss in urine (more than 3.5g per day — called nephrotic-range proteinuria), low blood protein levels (hypoalbuminemia — albumin below 3.0g/dL), significant swelling throughout the body (oedema), and elevated blood cholesterol and triglycerides (hyperlipidaemia). Together, these abnormalities create a serious medical syndrome that requires prompt specialist treatment.

Nephrotic syndrome can affect people of any age — from young children to elderly adults. In children (peak age 2-6 years), it is most commonly caused by minimal change disease, which responds well to steroids. In adults, the spectrum of causes is wider, and kidney biopsy is often needed to identify the specific type and guide treatment. Dr. Swaranjeet Kaur at Pragma Medical Institute, Bathinda has extensive experience managing nephrotic syndrome patients of all ages from across Punjab.

The 4 Key Features of Nephrotic Syndrome

Causes of Nephrotic Syndrome (by type of kidney disease)

In Children (Pediatric Nephrotic Syndrome)

• Minimal Change Disease (MCD) — Most common (70-80% of children). The glomeruli appear normal under light microscopy but show damage on electron microscopy. Excellent response to steroids — about 90% achieve complete remission.
• FSGS (Focal Segmental Glomerulosclerosis) — Some areas of the glomeruli show scarring. Less responsive to steroids. Can recur after kidney transplant.

In Adults

• Membranous Nephropathy — Most common cause of adult nephrotic syndrome in India. Often immune-mediated. Can be primary (anti-PLA2R antibody related) or secondary (to cancer, hepatitis B/C, drugs).
• FSGS — Primary or secondary (from HIV, obesity, reflux nephropathy).
• Diabetic Nephropathy — Advanced diabetic kidney disease can cause nephrotic syndrome.
• Amyloidosis — Abnormal protein deposits in kidney.
• Lupus Nephritis — Autoimmune kidney disease.

Symptoms of Nephrotic Syndrome — What Patients Experience

• Puffiness around eyes, particularly in the morning — often the first symptom noticed in children
• Progressive swelling in legs, ankles, and feet throughout the day
• Abdominal distension from fluid accumulation (ascites)
• Foamy or frothy urine from protein
• Significant weight gain from fluid retention
• Fatigue and weakness
• Loss of appetite
• In children: reduced activity, lethargy, abdominal pain from ascites

Dangerous Complications of Nephrotic Syndrome

Diagnosis of Nephrotic Syndrome

• 24-hour urine protein (or spot urine protein:creatinine ratio) — confirms nephrotic range
• Serum albumin — to document hypoalbuminaemia
• Fasting lipid profile — elevated cholesterol and triglycerides
• Serum creatinine and eGFR
• Urine microscopy — for red cell casts, lipid bodies
• ANA, ANCA, anti-dsDNA — to screen for lupus and vasculitis
• Hepatitis B, C, and HIV testing — common secondary causes
• PLA2R antibody — specific marker for membranous nephropathy
• Kidney biopsy — usually essential in adults to determine exact type

Treatment of Nephrotic Syndrome at Pragma Medical Institute, Bathinda

1. Steroids (Prednisolone)

The cornerstone of treatment for most nephrotic syndromes. Children with nephrotic syndrome typically receive a standard course of prednisolone — most achieve complete remission (urine becomes protein-free) within 4-8 weeks. Adults with MCD also respond well. Adults with membranous nephropathy or FSGS may require prolonged steroid courses and additional immunosuppressants.

2. Immunosuppressant Medicines

For steroid-resistant, steroid-dependent, or frequently relapsing nephrotic syndrome: cyclophosphamide, mycophenolate mofetil, tacrolimus, or rituximab (a biological medicine) may be used. Dr. Swaranjeet Kaur carefully selects the most appropriate agent based on the patient's specific biopsy finding, disease course, and risk profile.

3. Supportive Treatment

• ACE inhibitors or ARBs — reduce protein leakage and protect kidneys
• Diuretics (furosemide) — to control oedema and relieve swelling
• Statins — to manage high cholesterol and reduce cardiovascular risk
• Anticoagulants (blood thinners) — for high-risk patients with very low albumin to prevent dangerous clots
• Low-sodium diet — essential to control fluid retention and maximise diuretic effect
• Dietary protein: avoid excessive restriction; adequate protein intake important while also reducing glomerular protein leakage with medicines
• Infection prevention: pneumococcal vaccine, influenza vaccine; prompt treatment of any infection

4. Treating Relapse

Nephrotic syndrome, especially in children, can relapse (return) after the initial steroid course. Dr. Swaranjeet Kaur has a clear protocol for managing relapses with the appropriate steroid dose and, when needed, steroid-sparing immunosuppressants to reduce long-term steroid side effects.