Nephrotic Syndrome in Children: Causes, Symptoms & Treatment

Quick Answer

If your child has been diagnosed with nephrotic syndrome (a kidney condition), know that while it requires careful management, most children respond well to treatment! Nephrotic syndrome causes protein to leak into urine, leading to swelling (soojan), especially around eyes and legs. With proper medication and diet, about 80-90% of children achieve remission. It often recurs, but can usually be controlled.

What is Nephrotic Syndrome?

In Simple Terms:

• Kidneys lose too much protein through urine

• Blood doesn’t have enough protein

• This causes fluid to leak into body tissues

• Results in swelling, especially face and legs Key Facts:

• More common in children (especially boys ages 2-6)

• Affects about 2-7 per 100,000 children

• Usually responds well to steroid treatment

• Can recur but usually remains treatable

What Causes Nephrotic Syndrome

Primary Causes (Most Common in Children):

Type	Description	Response to Treatment
Minimal Change Disease	Most common (75-85%)	Usually responds well
Focal Segmental Glomerulosclerosis (FSGS)	Scarring in kidney	Variable response
Membranous Nephropathy	Rare in children	Variable response

Secondary Causes (Less Common):

• Infections (hepatitis, HIV)

• Diabetes

• Lupus

• Certain medications

• Other autoimmune conditions Often Unknown:

• Many cases have no identifiable cause

• Not caused by anything parents did wrong

• May have genetic component

Symptoms to Watch For

Classic Signs (Soojan/Swelling):

• Puffy eyes (especially morning - aankhen sooji hui)

• Swelling in feet, ankles, legs

• Swelling in abdomen (pet phula hua)

• Weight gain from fluid

• Decreased urine output

• Foamy/frothy urine Other Symptoms:

• Fatigue

• Loss of appetite

• Irritability

• Diarrhea (sometimes)

• High blood pressure (sometimes) How Parents Usually Notice:

• Morning puffiness around eyes

• Clothes or shoes feeling tight

• Sudden weight gain

• Less frequent urination

Home Management

Diet During Active Disease:

Do	Don’t
Low salt (namak kam)	No added salt, pickles, papad
Normal protein (unless advised otherwise)	Avoid excessive protein
Adequate fluids (as advised)	Avoid excessive fluids
Fresh fruits and vegetables	Avoid processed foods
Home-cooked food	Avoid packaged/junk food

Low-Salt Indian Food Tips:

• Cook without salt, add minimum at table

• Avoid: namkeen, chips, biscuits, papad, pickles

• Use fresh herbs and spices for flavor

• Make roti, sabzi with minimal salt

• Avoid: processed foods, canned foods Monitoring at Home:

• Weigh child daily (same time, same clothes)

• Check for urine protein (strips provided by doctor)

• Measure fluid intake and urine output if advised

• Watch for swelling changes

When to See a Doctor

Seek immediate care if:

• Severe abdominal pain

• High fever with chills

• Severe headache

• Blood in urine

• Difficulty breathing

• Severe swelling

• Child becomes lethargic

• Vomiting preventing medication Schedule appointment if:

• New or increasing swelling

• Urine test shows protein after remission

• Weight gain despite diet

• Questions about medications

• Side effects from steroids

Treatment Options

Steroid Treatment (Main Treatment):

• First-line treatment for most cases
• Usually prednisolone
• Response usually seen in 2-4 weeks
• Tapered gradually over weeks/months
• Most children respond well Typical Treatment Timeline:

Phase	Duration	What Happens
Initial treatment	4-6 weeks	High dose steroids
Tapering	Several weeks	Gradually reduce dose
Maintenance	Varies	Low dose or stop
Relapse	If occurs	Restart treatment

Other Medications (if needed):

• Diuretics (to reduce swelling)
• ACE inhibitors (to protect kidneys)
• Immunosuppressants (if steroid-resistant)
• Blood thinners (sometimes)
• Antibiotics (during relapse risk)

Managing Steroid Side Effects

Common Side Effects:

Side Effect	Management
Increased appetite	Monitor diet, avoid excess weight gain
Moon face	Temporary, improves after stopping
Mood changes	Be patient, inform doctor if severe
Sleep problems	Give medication in morning
Increased infection risk	Avoid sick contacts, maintain hygiene
Growth effects	Usually temporary

Important:

• Don’t stop steroids suddenly
• Always follow prescribed schedule
• Side effects are temporary
• Benefits usually outweigh risks

Prevention of Relapses

Trigger Avoidance:

• Prevent infections (good hygiene, avoid sick people)

• Up-to-date vaccinations (as advised by doctor)

• Treat infections early

• Avoid unnecessary medications Lifestyle:

• Healthy, low-salt diet

• Adequate rest

• Regular follow-ups

• Monitor urine regularly Warning Signs of Relapse:

• Puffy eyes in morning

• Weight gain

• Decreased urination

• Protein in urine (home test)

Long-Term Outlook

Good News:

• Most children (80-90%) respond to steroids

• Many children “grow out of it” by teen years

• Kidney function usually remains normal

• Most lead normal lives What to Expect:

• Relapses are common (but treatable)

• May need repeated steroid courses

• Some children need other medications

• Regular monitoring important

Expert Insight: Dr. Sumitra advises: ‘Growth charts are just one tool. Look at the overall trend, not individual measurements.‘

FAQs

Q: Mera bachcha ka chehra subah sooja hua rehta hai - could it be nephrotic syndrome?

A: Morning puffiness around eyes (especially if it reduces during the day) can be an early sign of nephrotic syndrome. However, it can also be due to allergies, crying, or other causes. If you notice: persistent morning puffiness, swelling in feet/legs too, decreased urination, or foamy urine - get a urine test done immediately. A simple urine test can detect protein and help diagnose.

Q: My child has nephrotic syndrome - can they eat normal food?

A: During active disease (relapse), follow a low-salt diet to reduce swelling. Protein intake should be normal (not restricted) unless advised otherwise. Avoid: added salt, pickles, papad, packaged foods, and chips. Use fresh home-cooked food with minimal salt. When in remission, diet can be more relaxed but maintaining low salt is still helpful. Consult your nephrologist for specific advice.

Q: Steroids dene se mujhe dar lagta hai - are they safe?

A: We understand the concern! Steroids do have side effects, but they are the most effective treatment for nephrotic syndrome. Side effects like increased appetite and moon face are temporary and resolve after stopping. The alternative (untreated nephrotic syndrome) carries more serious risks. Follow your doctor’s dosing carefully - never stop suddenly. The benefits far outweigh the risks when used properly.

Q: Will my child have kidney problems for life?

A: Most children with nephrotic syndrome have an excellent outlook! The most common type (Minimal Change Disease) usually doesn’t cause permanent kidney damage. Many children “outgrow” it by teenage years. Even children who have frequent relapses usually maintain normal kidney function. Regular follow-up helps catch and treat any issues early.

Q: Relapse ho gaya - what should I do?

A: If you notice signs of relapse (morning puffiness, weight gain, protein in urine test), contact your doctor promptly. Early treatment of relapse usually leads to quick response. Don’t panic - relapses are common and expected in nephrotic syndrome. Your doctor will advise on restarting steroids or adjusting treatment. Keep monitoring and following up regularly.

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This article was reviewed by a pediatrician. Last updated: January 2025

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