Nephrotic syndrome in children..

Patient's question:

Nephrotic syndrome in children

Doctor's answer:

Hello, Nephrotic syndrome is most commonly seen in children aged 3 to 6, and boys are more affected than girls. The exact cause is unclear, and it tends to recur and persist, with a long course. Even during periods of stable condition, children generally still need medication. Parents should check their child's medication adherence daily. Since children typically take diuretic hormone drugs, their urine output increases, requiring special attention from parents. It is also important to remind them to use the restroom promptly during activities to avoid unnecessary discomfort.
This disease is a clinical syndrome caused by multiple factors. Its characteristics include significant edema, large amounts of proteinuria, hypoproteinemia, and hypercholesterolemia. It is commonly referred to as "nephrosis." Based on the cause, it can be classified as:
(1) Primary nephrosis: Associated with immune dysfunction.
- Simple nephrosis (most common type), seen in children aged 2 to 7. In addition to nephrotic symptoms, it does not involve microscopic hematuria or hypertension. Renal biopsy results in over 90% are classified as minimal change disease.
- Renal inflammatory nephrosis, more common in children over 7. In addition to nephrotic symptoms, it may involve microscopic hematuria or hypertension. Renal biopsy results, apart from minimal change disease, may show proliferative changes, membranoproliferative changes, or sclerotic changes.
(2) Secondary nephrosis: Secondary to conditions such as malaria, insect bites, systemic lupus erythematosus, allergic purpura, metal or drug poisoning, etc.
(3) Congenital nephrosis: Less common, occurring in infancy.
Laboratory tests in children with nephrotic syndrome may reveal decreased plasma albumin, causing the normal albumin-to-globulin ratio (1:1.5) to invert to 0.5:1, with elevated plasma cholesterol. Some children may develop skin streaks resembling those of pregnant individuals (white or purple) on their thighs, inner arms, abdomen, and chest. Urine output may significantly decrease. Due to the long-term loss of large amounts of protein through urine, symptoms of protein malnutrition may appear, including dry, yellowish hair, keratosis of hair follicles, dry skin, white horizontal lines on nails, delayed development, anemia, and increased susceptibility to infections. Some children may also have hematuria and hypertension.
Children with nephrotic syndrome should follow a low-sodium diet: Patients with edema or hypertension are advised to consume a low-sodium diet, with 1-3 grams of salt per day, or use low-sodium salt. Salted rock salt from traditional Chinese medicine can also be used as a low-sodium alternative. The method involves dissolving an appropriate amount of salted rock salt in water, filtering it, and then boiling the filtered liquid to concentrate it.
Children with nephrotic syndrome can consume moderate amounts of vegetables and fruits. Those with reduced urine output are particularly suitable for eating winter melon and watermelon. Foods to avoid include grilled, fried, and spicy foods. The diet should be high in calories, high in protein, low in fat, low in sodium, and high in calcium while being rich in vitamins. However, children often have poor appetite and are reluctant to eat, making it difficult to supplement high protein and high calories. Therefore, cooking techniques should be improved, focusing on the color, aroma, and taste of food while reducing portion sizes and enhancing quality to meet the requirements of nephrotic nutrition therapy.
To maintain sufficient energy for the body to recover, high-carbohydrate foods should be provided, such as rice, noodles, or honey or glucose. To replenish lost protein and support growth and development, protein should be supplied at a rate of 3-5 grams per kilogram of body weight, with a balanced ratio of animal and plant proteins. Fats should be obtained from plant-based foods such as vegetable oil and margarine.