Tests and procedures used to diagnose nephrotic syndrome include:
- Urine tests. A urinalysis can reveal abnormalities in your urine, such as large amounts of protein, if you have nephrotic syndrome. You may be asked to collect urine samples over 24 hours for an accurate measure of the protein in your urine.
- Blood tests. If you have nephrotic syndrome, a blood test may show low levels of the protein albumin (hypoalbuminemia) specifically and often decreased levels of blood protein overall. Loss of albumin is often associated with an increase in blood cholesterol and blood triglycerides. Serum creatinine and blood urea also may be measured to assess your overall kidney function.
- Removing a sample of kidney tissue for testing. Your doctor may recommend a procedure called a kidney biopsy to remove a small sample of kidney tissue for testing. During a kidney biopsy, a special needle is inserted through your skin and into your kidney. Kidney tissue is collected and sent to a lab for testing.
Treatment for nephrotic syndrome involves treating any underlying medical condition that may be causing your nephrotic syndrome. Your doctor may also recommend medications that may help control your signs and symptoms or treat complications of nephrotic syndrome. Medications may include:
- Blood pressure medications. Drugs called angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure and also reduce the amount of protein released in urine. Medications in this category include benazepril (Lotensin), captopril and enalapril (Vasotec). Another group of drugs that works in a similar way is called angiotensin II receptor blockers (ARBs) and includes losartan (Cozaar) and valsartan (Diovan). Other medications, such as renin inhibitors, also may be used, though ACE inhibitors and ARBs are generally used first.
- Water pills. Water pills (diuretics) help control swelling by increasing your kidneys' fluid output. Diuretic medications typically include furosemide (Lasix). Others may include spironolactone (Aldactone) and thiazides, such as hydrochlorothiazide.
- Cholesterol-reducing medications. Medications called statins can help lower cholesterol levels. However, it's currently unclear whether or not cholesterol-lowering medications can specifically improve the outcomes of people with nephrotic syndrome, such as avoiding heart attacks or decreasing the risk of early death. Statins include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
- Blood thinners. Medications called anticoagulants help decrease your blood's ability to clot and may be prescribed if you've had a blood clot to reduce your risk of future blood clots. Anticoagulants include heparin, warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), apixaban (Eliquis) and rivaroxaban (Xarelto).
- Immune system-suppressing medications. Medications to control the immune system, such as corticosteroids, may decrease the inflammation that accompanies underlying conditions, such as minimal change disease, lupus and amyloidosis.
Lifestyle and home remedies
Changes to your diet may help you cope with nephrotic syndrome. Your doctor may refer you to a dietitian to discuss how what you eat can help you cope with the complications of nephrotic syndrome. A dietitian may recommend that you:
- Choose lean sources of protein
- Reduce the amount of fat and cholesterol in your diet to help control your blood cholesterol levels
- Eat a low-salt diet to help control the swelling (edema) you experience
- Limit foods that increase blood sugar levels when taking medications that can lead to weight gain, such as steroids
Some people with nephrotic syndrome may also be deficient in the mineral zinc. A recent study showed treatment with zinc supplements in children under 18 improved nephrotic syndrome. But always check with your doctor before giving your child a supplement or taking one yourself to avoid any potential adverse interactions.
Preparing for your appointment
If you have signs and symptoms that cause concern, start by seeing your primary care doctor. If your doctor suspects you have a kidney problem, such as nephrotic syndrome, you may be referred to a doctor who specializes in the kidneys (nephrologist).
Here's some information to help you get ready for your appointment and what to expect from your doctor.
What you can do
Before your appointment:
- Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
- Write down symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Consider taking a family member or friend along, to help you remember all the information provided during the appointment.
- Write down questions to ask your doctor.
Preparing a list of questions ahead of time can help you make the most of your time with your doctor. For nephrotic syndrome, some basic questions to ask your doctor include:
- What's the most likely cause of my nephrotic syndrome?
- What tests do I need?
- Is this condition likely temporary, or will I always have it?
- What are my treatment options? And which do you recommend for me?
- What are the risks and benefits of each treatment?
- Are there changes I can make to my diet to help me feel better? Could a dietitian help me?
- I have other health conditions. How can I best manage these conditions together?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
- How do I know when I need to plan for a follow-up visit? Are there any symptoms that suggest I should call for advice right away?
In addition to the questions that you prepare ahead of time, don't hesitate to ask other questions that occur to you during your visit.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- When did you first notice your symptoms?
- Do your symptoms come and go, or do you have them all the time?
- How severe are your symptoms?
- Does anything seem to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
Jan. 30, 2018
- Ferri FF. Nephrotic syndrome. In: Ferri's Clinical Advisor 2018. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Oct. 28, 2017.
- Kasper DL, et al., eds. Glomerular diseases. In: Harrison's Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill Education; 2015. http://accessmedicine.mhmedical.com. Accessed Oct. 28, 2017.
- Nephrotic syndrome in adults. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/nephrotic-syndrome-adults. Accessed Oct. 30, 2017.
- Kelepouris E. Overview of heavy proteinuria and the nephrotic syndrome. https://www.uptodate.com/contents/search. Accessed Oct. 28, 2017.
- Kong X, et al. Lipid-lowering agents for nephrotic syndrome (Review). Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005425.pub2/full. Accessed Oct. 28, 2017.
- Bhatt GC, et al. Zinc supplementation as an adjunct to standard therapy in childhood nephrotic syndrome - a systematic review. World Journal of Clinical Pediatrics. 2017;5:383.
- Hickson LJ (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 4, 2017.
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