Nephrotic Syndrome: Causes, Symptoms, and Treatment

ABSTRACT

A healthy human body consists of two kidneys that filter your blood. Each of our kidneys consists of millions of nephrons which removes toxins and excessive fluid from the blood. The most common wastes are ammonia, urea (nitrogen waste), creatinine (muscle waste), excessive amounts of salts etc. which are then excreted out in urine. When the proteins start excreting in urine, which is not a waste, Nephrotic syndrome develops. It is considered autoimmune in origin. It commonly affects children between the ages of 2-9 years. This results from damage to the glomeruli, the tiny filtering units within the kidneys. The syndrome is most commonly seen in children, but adults can also be affected.

INTRODUCTION

Nephrotic syndrome refers to a clinical condition that develops when the kidneys fail to retain protein during the filtration process, leading to a significant loss of protein (especially albumin) in the urine. This condition results in a series of characteristic symptoms and can lead to complications such as fluid retention (edema), high cholesterol levels, and increased risk of infections. Nephrotic syndrome can either be primary (occurring directly in the kidneys) or secondary (resulting from systemic diseases such as diabetes or lupus). While nephrotic syndrome itself is not a disease, it is a syndrome indicative of kidney dysfunction and often requires long-term management.

CAUSES

• Minimal Change Disease (MCD) : Most commonly seen in children. It is characterized by minimal changes to the kidney’s glomeruli under a microscope, but significant protein loss occurs in the urine.
• Membranous Nephropathy (MN) : An autoimmune condition in which the immune system damages the glomeruli, leading to thickening of the glomerular basement membrane.
• IgA Nephropathy : This primarily presents as hematuria (blood in the urine), but can develop into nephrotic syndrome.
• Diabetic Nephropathy : Long-term diabetes can damage the glomeruli, leading to protein leakage and nephrotic syndrome.
• Systemic Lupus Erythematosus (SLE) : This can cause inflammation and damage in various organs, including the kidneys.
• Infections : Conditions such as HIV, hepatitis B, and malaria can lead to nephrotic syndrome as a secondary complication.
• Drugs and Medications : Certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) and prolonged exploitation of antibiotics.
• Cancer : Some cancers, particularly those involving the kidneys or other organs, can cause nephrotic syndrome.
• Other Renal conditions like Glomerulosclerosis [scarring in renal parenchyma], Glomerulonephritis [renal inflammation] can sometimes lead to increased protein secretion in urine.

SYMPTOMS

The hallmark symptom of nephrotic syndrome is edema (swelling), which initially starts developing as periorbital edema and later develops in other parts. The other key symptoms include

• Swelling: Initially swelling around eyes, face, ankles, legs, and abdomen is seen due to fluid retention. In advanced stages, the swelling gets generalized in the whole body. In some cases, scrotal edema can also be seen.
• Foamy Urine: Due to high protein levels in the urine (proteinuria), the urine appears frothy with a whitish and viscid appearance.
• Loss of Appetite: It is often accompanied by nausea and weight loss.
• Fatigue: As a result of protein loss and fluid retention.
• High Blood Pressure: Kidney dysfunction can lead to associated increased blood pressure, further worsening the condition.
• Infections: Frequent or recurrent infections can occur due to the loss of immune proteins in the urine.

SIGNS

• Edema (Swelling): This is the most visible sign and is often most pronounced around the eyes, ankles, and abdomen.
• Hypoalbuminemia: Low levels of albumin in the blood due to its loss in the urine.
• Hyperlipidemia: Increased cholesterol and triglyceride levels are commonly seen.
• Proteinuria: Excessive protein in the urine, typically greater than 3.5 grams per day.
• In the advanced cases, it is clinically seen that the fluid oozes out from the pores present in the skin.

DIAGNOSIS

1. Clinical analysis of patient: Physical examination of patient will be a key diagnostic feature but for a confirmatory diagnosis further blood examination is done.
2. Urinalysis: The presence of large amounts of protein in the urine (greater than 3.5 grams per day) is a key indicator.
3. Blood Tests: CBCs, Lipid Profile, KFT are regularly done too assess protein levels (albumin), cholesterol, and kidney function (creatinine and blood urea nitrogen).
4. Vitamin D3 and Vitamin B12 are advised bi-annually.
5. Renal Biopsy: In some cases, a biopsy may be required to determine the cause of nephrotic syndrome.
6. Imaging: USG can be done to assess the damage in renal parenchyma.

TREATMENT

Treatment according to the presentation of the symptoms is done.

1. Medications
   • Corticosteroids : It is the first line of treatment to reduce the inflammation and immune response (especially in conditions like Minimal Change Disease).
   • Immuno-suppressants : Drugs like cyclophosphamide may be used to suppress the immune system in cases like FSGS or membranous nephropathy.
   • ACE Inhibitors : To reduce the associated hypertension and protein loss in urine.
   • Diuretics : To help reduce fluid retention and swelling.
   • Statins : To manage hyperlipidemia.
2. Dietary Modifications
   • Low-Salt Diet : Helps in controlling fluid retention and edema.
   • Protein-Controlled Diet : Adjusting protein intake based on kidney function.
3. Dialysis : In cases where kidney function is severely compromised, dialysis may be required temporarily or long-term.
4. Kidney Transplant : In cases of end-stage kidney failure, a kidney transplant is the only viable option.

AYURVEDIC OVERVIEW

In Ayurveda, there is no direct correlation mentioned for Nephrotic syndrome. But the symptoms and disease manifestation can be correlated to a type of Kaphaj prameha like “Sandra-meha” or Kaphaj shotha. According to Ayurvedic principles, Nephrotic Syndrome is caused by the “Stroto-sangha” i.e., obstruction in srotas due to kapha dosha. Even if no direct correlation is explained classically, the treatment nonetheless remains the same and effective, which is done on the basis of fundamental principles of Ayurveda.

The pathophysiology of this disease involves the vitiation of all the tridoshas but mainly kapha dosha followed by vata dosha is affected. Also because of vitiated kapha and vata dosha, our Agni [digestive fire] gets decreased leading to Agni-mandhyata [slowing down of our digestive fire] and leads to formation of Aam [toxins]. Due to this the Rasa [nutritive juice from after digestion], Mutra [excretory system], Udaka [lymphatic system] and Ojas [immunity] are involved. When these srotas are obstructed, the fluid retention begins and edema develops. Since Ojas [immunity] is also involved, Bala-kshyaya [weakness] also occurs.

In Ayurvedic principles, the tissue damage can be healed and prevented with the use of Rasayana therapy. Use of “Vardhman Pippali Rasayan” can be done. Haritakyadi kashayam which is indicated in both “mutrakrichta” [retention of urine] and prameha [diabetes] roga can be used here. Also Gokshuradhi Guggul, Varunadhi kashayam, Patoladhi kashayam, Agnitundi vati etc are indicated to use to pacify the vitiated kapha dosha. Kansa-Haritaki and Gud-Adraka are classically indicated in “Shotha-chikitsa” for reducing severe edema.

AYURVEDIC HERBS BENEFICIAL IN NEPHROTIC SYNDROME

1. Haridra / Curcuma longa
   Commonly known as Haldi, it increases our Agni (metabolic fire) because of its ushna veerya [hot potency], Tikta [pungent] rasa and Katu [bitter] rasa. It digests Ama (toxins) and balances tri-doshas. Haridra removes the blockage in “srotas” [circulatory channels] which are created by vitiated Pitta and Kapha dosha and allows the free movement of Vata. It balances vata due to its Ushna veerya (hot potency); Kapha because of its Rooksha (dry), Katu (bitter), and Tikta [pungent] rasa and also Pitta due to its Tikta (pungent) guna. Haridra is helpful in immune-modulation by correcting our metabolism, enabling free circulation of nutrients & oxygen to every cell due to its antioxidant properties. It is also “Vishothahar” i.e., it is naturally anti-inflammatory.

2. Bhumi-amlaki / Phyllanthus niruri
   This herb helps to balance an aggravated Kapha due to its Tikta (bitter) and Kashaya (astringent) rasa, along with its Laghu (light) and Rooksha (dry) qualities. It also influences Pitta, due to its Madhur (sweet) rasa and cooling potency i.e., sheeta veerya. The alkaloids phyltetralin and nirtetralin found in Bhumiamla are effective in alleviating swelling in the feet (pedal edema), and extracts from its leaves have been shown to enhance kidney function. Additionally, it is recognized for its antioxidant and antiviral properties.

3. Varuna / Crateava nurvula
   The extract derived from the bark of Varuna is rich in beneficial alkaloids such as rutin, quercetin, and varunol, which are known for their powerful diuretic and lithotriptic properties. Varun chhal (the bark) is particularly effective in supporting kidney health by helping to lower creatinine levels. It achieves this by increasing urine output, which aids in the elimination of excess waste products from the body, thereby reducing creatinine levels in the blood. Varuna is highly regarded for its ability to balance vitiated Kapha and Vata doshas. Its therapeutic effects can be attributed to its Ushna (hot) potency, which helps in stimulating the body’s natural processes and alleviating the stagnation associated with an imbalance of Kapha. Additionally, its Tikta rasa (bitter) and Kashaya rasa (astringent) contribute to its detoxifying and cleansing actions, which help in balancing excessive moisture, promoting proper digestion, and improving overall metabolic function.

4. Punarnava / Boerhavia diffusa:
   Punarnava is a powerful herb with potent diuretic and anti-inflammatory properties, primarily its Tikta rasa (bitter) and Kashaya rasa (astringent) tastes. The entire plant, from the roots to the flowers, is utilized for its therapeutic benefits, but the extracts from the roots are considered the most potent and effective. The leaves of Punarnava are often consumed as a vegetable in many regions across India. It helps to reduce edema (swelling caused by fluid retention). Its diuretic action significantly reduces water retention in the body. Punarnava is known for its excellent blood-purifying qualities. It supports the body’s natural detoxification processes, helping to cleanse the blood of toxins and impurities. This purification process can also aid in boosting the hemoglobin (Hb) count, enhancing oxygen-carrying capacity.

5. Gokshur / Tribulus terrestris
   Gokshura is a powerful Mutral (diuretic) herb, known for its ability to promote urine production and support the healthy functioning of the urinary system. It is considered tridosha shamak, meaning it has the ability to balance all three doshas—Vata, Pitta, and Kapha. However, due to its predominance of Madhura rasa (sweet taste) and Sheet veerya (cool potency), Gokshura is particularly beneficial for managing an aggravated Pitta dosha, helping to soothe the excess heat and inflammation associated with Pitta imbalance. Also referred to as Trikantaka, Gokshura has a notable effect on blood sugar levels, earning it the title of prameha-hara, making it a valuable herb for managing diabetes.

6. Palaash / Butea monosperma
   Also known as Flame Tree, it is beneficial for balancing both Kapha and Pitta doshas. Its bark has Ushna veerya (hot potency), which is effective in calming excess Kapha, while the root possesses Sheet veerya (cool potency), which helps soothe aggravated Pitta. This unique combination of hot and cool qualities allows it to balance all the tridoshas. The flowers of the Palaash (Flame Tree) are effective in improving kidney function by reducing inflammation, aiding the elimination of toxins, and removal of excess uric acid from our blood. Furthermore, it is alkaline in nature, thus acts as a urine alkalizer creating a more favorable environment for our kidneys.

HERBAL REMEDIES FOR NEPHROTIC SYNDROME BY PLANET AYURVEDA

Planet Ayurveda, a GMP certified company provides a combination of ayurvedic herbs for the management of Nephrotic Syndrome. With the use of above-mentioned herbs, planet Ayurveda has compiled the “Nephrotic Syndrome Care Pack”. This pack includes Mutrakrichantak Churna, Curcumin Capsules, Chandanadi Vati and Phyllanthus niruri Capsules. All the Planet Ayurveda medicines are 100 % natural, vegetarian, additive free, chemical & preservative free and without any side effects. With ayurvedic intervention, the Nephrotic Syndrome can be managed efficiently and thus, increasing the quality of life.

PRODUCT DESCRIPTION

Mutrakrichantak Churna

This churna is prepared with the standardized extract derived from the bark of varuna (Crataeva nurvala), fruits of gokshura (Tribulus terrestris), and Panchanga (whole plant) of bhumi-amalaki (Phyllanthus niruri) & kalmegh (Andrographis paniculata). It can balance out all the tridoshas. Since these herbs have mutral (diuretic) effect, it helps in lowering the raised creatinine levels and loss of protein through urine, improving glomerular filtration of blood in kidneys. It is also helpful in reducing burning urine.

DOSAGE : 1 teaspoonful with water after meals

Curcumin Capsules

These capsules contain a standardized extract of Curcuma longa, which has potent concentration of the Curcumin, which is the active alkaloid. Curcumin is known for its powerful antioxidant, anti-inflammatory, and healing properties. These capsules support metabolism and promote the efficient circulation of essential nutrients and oxygen to every cell due to their antioxidant effects. By neutralizing free radicals, Curcumin plays a role in cancer prevention and treatment. Similar to non-steroidal anti-inflammatory drugs (NSAIDs), Curcumin exhibits anti-inflammatory effects, making it beneficial for managing conditions like osteoarthritis, rheumatoid arthritis (RA), and other inflammatory disorders.

DOSAGE : 2 capsules twice daily after meals with warm water.

Chandanadi Vati

Chandanadi vati is available in form of tablets which are prepared using standardized extract derived from Chandan (Santalum album), kabab-chini (Piper cubeba), elaichi (Elettaria cardamom), amlaki (Phyllanthus emblica) and other herbs having similar benefits. It is helpful in removing excessive kapha dosha, aama (toxins) from the body. Chandan balances excess heat due to its sheeta veerya (cool potency). Chandan is also a diuretic, urine alkalizer and prevents infections. Amalaki helps in balancing tridoshas as it cleanses the bladder and relieves the burning sensation. Ela is efficient in reducing inflammation and kabab-chini is known for its antimicrobial properties.

DOSAGE : 2 tablets thrice daily after meals with warm water.

Phyllanthus niruri Capsules

These capsules are prepared from the standardized extracts derived from the whole plant of bhumi amalaki (Phyllanthus niruri). The extracts obtained from this herb are known to stimulate repair mechanisms and reduce the oxidative stress on renal parenchyma. Bhumi-amlaki is known for reducing pedal edema or any other associated swelling in the body. This herb has Mutral [diuretic] properties and is of cool potency that helps in increasing the urine flow. This herb pacifies our Kapha and Pitta dosha.

DOSAGE : 2 capsules twice daily after meals with warm water.

CONCLUSION

Nephrotic syndrome is a complex condition that requires careful management to avoid complications such as kidney failure. Early diagnosis, appropriate treatment, and lifestyle changes are essential for improving outcomes. Ayurveda offers promising support in managing the symptoms and improving quality of life. With timely intervention and a comprehensive treatment plan, individuals with nephrotic syndrome can lead fulfilling lives while managing the condition effectively and preventing further kidney damage.