Does protein leak from the larger filter of the kidney?

Question

Hi doctor,

I heard that in nephrotic syndrome the filtering unit of kidney becomes larger and so protein comes in urine. I am a patient of cortisone dependent nephrotic syndrome over 15 years. Doctor says that about 95 percent of children will get cured at the age of 18. I am 17 years old now. When a child grows, does the filtering unit become smaller? And what happens to the remaining 5 percent? I have anemia, but otherwise normal. Only albumin comes in urine. I also heard that kidney biopsy is done for nephrotic syndrome. But no doctor advised me for biopsy. Do I have minimal change disease?

Answer 1

Hi,

Welcome to icliniq.com.

Yes, you have heard the things right. Due to increased pore size, protein is present in the urine. The best treatment remains the Cortisone. In cases where there is no response to Cortisone as evidenced by the persistence of albumin in urine, we need to shift those patients on Cyclophosphamide and Azathioprine.

Renal biopsy can be performed, but since you are on steroids, the reports may be altered. You need to obtain C3 (complement component 3), C4 (complement component 4), ANA (antinuclear antibody), ANCA (antineutrophil cytoplasmic antibody), and the urine protein-to-creatinine ratio.

I hope this helps.

Answer 2

Hi,

Welcome back to icliniq.com.

These tests are performed to rule out any evidence of autoimmune kidney dysfunction, which can cause such issues. The most common reason is idiopathic nephrotic syndrome, but we call it idiopathic only when we are sure there are no other causes.

A rise in serum creatinine does not commonly occur in nephrotic syndrome. We need the urine protein-to-creatinine ratio to monitor albuminuria as a guide to diagnosis. I would recommend, in such a case, obtaining either a 24-hour urine protein test or a protein-to-creatinine ratio.

I hope this helps.