Complications of Nephrotic Syndrome: What You Need to Know
Nephrotic syndrome is a serious kidney disorder characterized by excessive protein in the urine, low levels of protein in the blood, high cholesterol, and swelling—particularly around the eyes, feet, and hands. While managing the primary symptoms is crucial, it's equally important to understand the potential complications associated with this condition. Early recognition and proactive treatment can significantly improve patient outcomes and quality of life.
Increased Risk of Infections
One of the most common complications of nephrotic syndrome is a heightened susceptibility to infections. This vulnerability stems from several interrelated factors, including prolonged use of corticosteroids, poor nutritional status, and impaired immune function. Corticosteroid therapy, while effective in reducing inflammation and proteinuria, can suppress the body's natural defense mechanisms. As a result, patients are more prone to bacterial and viral infections, particularly in the respiratory tract, urinary system, and skin. Pneumonia, urinary tract infections (UTIs), and cellulitis are frequently reported among affected individuals.
Children and elderly patients appear to be at even greater risk. Preventive measures such as vaccinations (e.g., pneumococcal and influenza vaccines) and maintaining good hygiene are strongly recommended. Prompt diagnosis and antibiotic therapy are essential when infections do occur to prevent progression to sepsis or other systemic complications.
Blood Clots and Embolism
Thromboembolic events represent another major concern for people with nephrotic syndrome. The condition often leads to a hypercoagulable state—meaning the blood is more likely to clot—due to factors such as hemoconcentration (thicker blood from fluid loss), elevated lipid levels, and abnormalities in clotting proteins.
Common Sites of Thrombosis
Clots can form in various parts of the body, but the most dangerous include:
- Deep vein thrombosis (DVT), especially in the legs
- Renal vein thrombosis, which directly affects kidney function
- Pulmonary embolism, a life-threatening blockage in the lung arteries
Symptoms like sudden leg swelling, chest pain, or shortness of breath should be treated as medical emergencies. Anticoagulant medications may be prescribed in high-risk cases to help prevent clot formation.
Acute Kidney Injury
Another serious complication is acute kidney injury (AKI), which can develop rapidly in patients with nephrotic syndrome. This is often triggered by reduced blood volume—also known as hypovolemia—resulting from significant protein and fluid loss through urine. When blood flow to the kidneys drops, their ability to filter waste diminishes, leading to a buildup of toxins in the bloodstream.
In some cases, overuse of diuretics (water pills) intended to reduce swelling can worsen volume depletion and further impair kidney perfusion. Close monitoring of blood pressure, electrolyte levels, and kidney function markers (such as creatinine and glomerular filtration rate) is essential during treatment.
Metabolic Imbalances: Lipid and Protein Disorders
Nephrotic syndrome profoundly disrupts normal metabolic processes, particularly those involving fats and proteins. The liver responds to low blood protein levels by increasing production of certain proteins, including lipoproteins, which leads to hyperlipidemia—elevated cholesterol and triglyceride levels.
This chronic lipid imbalance raises the long-term risk of cardiovascular diseases such as atherosclerosis, heart attack, and stroke. Additionally, the persistent loss of essential proteins through urine can lead to malnutrition, muscle wasting, and weakened immunity.
Managing these metabolic disturbances typically involves a combination of dietary modifications, lipid-lowering medications (like statins), and ongoing monitoring. A registered dietitian can play a key role in developing a balanced meal plan that supports overall health without overburdening the kidneys.
In conclusion, while nephrotic syndrome primarily affects kidney function, its ripple effects extend across multiple body systems. Awareness of these complications—ranging from infections and blood clots to metabolic issues and acute kidney damage—empowers patients and healthcare providers to take preventive action and optimize long-term outcomes.