Nephrotic Syndrome is one of the most common kidney problems seen in children. Although it can be frightening for parents, the good news is that most children respond very well to treatment and live completely normal lives. Understanding the condition helps parents manage it confidently and prevent unnecessary complications.
What Is Childhood Nephrotic Syndrome?
Nephrotic Syndrome is a condition where the kidneys leak large amounts of protein into the urine.
This happens because the filters in the kidneys (called glomeruli) become “leaky.”
The four key features are:
- Heavy protein loss in urine (Proteinuria)
- Low protein in blood (Hypoalbuminemia)
- Swelling of the body (Edema)
- High cholesterol levels
At What Age Does It Begin?
- Most commonly between 2 and 6 years of age
- More common in boys than girls
- Can occur in infants and older children, but less often
What Causes Nephrotic Syndrome in Children?
In most children, the cause is Minimal Change Disease (MCD) — a condition where the kidney looks normal under a microscope but leaks protein.
Other causes (rare):
- Focal segmental glomerulosclerosis (FSGS)
- Infections
- Genetic causes (especially in infants)
In the majority, the condition is not due to something the parents did or could have prevented.
What Are the Manifestations?
Common symptoms include:
- Swelling around the eyes (especially in the morning)
- Swelling of legs, feet, abdomen, and sometimes scrotum
- Weight gain due to fluid retention
- Frothy urine
- Decreased urine output
- Occasional tiredness or loss of appetite
Some children may have mild infections at the start.
How Is It Diagnosed?
Diagnosis is simple and involves:
1. Urine tests
- Urine dipstick showing heavy protein
- 24-hour urine protein (sometimes)
- Urine protein–creatinine ratio
2. Blood tests
- Albumin (low)
- Cholesterol (high)
- Kidney function tests
- Electrolytes
3. Additional tests
Kidney biopsy is not usually needed in typical childhood nephrotic syndrome unless:
- Poor response to steroids
- Blood in urine
- High blood pressure
- Onset below 1 year of age
- Suspicion of genetic or secondary causes
How Is It Treated?
1. Steroids (Prednisolone)
This is the main treatment.
Most children respond very well within 1–2 weeks.
Treatment continues for several weeks as per standard protocols.
2. Diuretics
For significant swelling.
3. Albumin infusions (rarely)
Only for severe swelling or breathing difficulty.
4. Additional medications
For children who have frequent relapses or become steroid-dependent:
- Levamisole
- Mycophenolate mofetil (MMF)
- Tacrolimus
- Cyclophosphamide
Treatment is individualized by the child’s nephrologist.
How Should Parents Monitor the Child?
Parents play a major role in managing nephrotic syndrome.
Daily home monitoring:
- Check urine protein using dipsticks
- Record daily weight
- Watch for swelling
- Watch for signs of infection
- Track fluid intake (if advised)
Parents should maintain a daily chart, which helps the doctor adjust treatment.
Follow-Up Schedule
Regular follow-up is vital:
- Weekly visits during active treatment
- Monthly during stable periods
- More frequently if relapses occur
Follow-up includes:
- Urine protein monitoring
- Blood pressure
- Growth and nutrition assessment
- Medication adjustment
- Vaccination review
What About Diet?
Salt restriction is essential.
Salt increases swelling and water retention.
Water restriction
Not required for all children, but advised if:
- There is significant swelling
- Sodium is low
- There is reduced urine output
Healthy, balanced diet is important for growth.
Schooling and Activities
Children with nephrotic syndrome can and should:
- Attend school normally
- Play and participate in activities
- Lead a normal childhood
During active swelling or infections, they may need temporary rest.
Vaccinations
Very important for preventing infections.
Children should receive:
- Annual flu vaccine
- Pneumococcal vaccine
- Hepatitis B (as per schedule)
Live vaccines should be avoided while the child is on high-dose steroids or immunosuppressants.
Always discuss with the child’s nephrologist.
Preventing Infections
Children with nephrotic syndrome are at higher risk of infections.
To reduce this:
- Practice good hand hygiene
- Avoid contact with sick individuals
- Ensure vaccinations are up to date
- Seek early treatment for fever
- Avoid unnecessary antibiotics unless advised
What About Recurrence?
About:
- 60–70% of children will have at least one relapse
- Many will have multiple relapses, especially in the first few years
- Relapses often occur after:
- Viral infections
- Vaccinations
- Allergies
- Missed medications
Most children outgrow frequent relapses by adolescence.
Long-Term Prognosis
The overall prognosis is excellent.
- 90% of children with minimal change disease maintain normal kidney function for life
- A small minority may develop steroid dependence or resistance and need additional medications
- Only a tiny fraction progress to chronic kidney disease
With proper management, most children grow normally and lead full, healthy lives.
Take-Home Messages for Parents
- Childhood Nephrotic Syndrome is common between 2–6 years and usually responds very well to treatment.
- Steroids are the main therapy, and most children improve quickly.
- Parents play a crucial role through daily urine checks, weight monitoring, infection prevention, and follow-up.
- Salt restriction is essential during active disease.
- Vaccinations are crucial—especially flu and pneumococcal vaccines.
- Relapses are common but manageable.
- Long-term prognosis is excellent in the majority of children.
If you are looking for the best nephrologist in Bangalore, Dr. Vinod Kumar K at Manipal Hospitals, Kanakapura Road stands out for his expertise in kidney diseases, dialysis care, renal transplantation, and critical care nephrology. With a patient centric approach and years of experience, he continues to be a trusted name for comprehensive kidney care.