Dr. Ninan Thomas Panicker

Nephrotic Syndrome is a condition which is characterised by the loss of protein into the urine (called proteinuria) as a result of increased glomerular permeability and oedema. This results in low protein level in the blood. The low levels of protein in blood result in the drawing of fluids into soft tissues. A severe form ‘hypoalbuminemia’ can cause scores of secondary diseases such as ascites (retention of fluid in the abdominal cavity), pleural effusion (build-up of fluids between the lungs and the chest), or high cholesterol. It can also result in retention of fluid in other parts of the body such as eyelids, lower extremities etc.

What can cause this?
Nephrotic syndrome is mainly caused by damage to the kidneys. This leads to an increase in the concentration of protein in the urine. In adults, it can be caused due to glomerulonephritis or damage to the glomerulus of the kidneys while in children it is likely caused by minimal change disease (kidney disease marked by the abnormal loss of protein through the urine).

The other common causes of nephritic syndromes are:

1. Genetic disorder
2. Immune disorder
3. Cancer
4. Infections
5. Use of specific drugs
6. Certain diseases such as diabetes mellitus, lupus
7. The incidence of this disease is seen more often in males than in females.

Diet that is recommended in Nephrotic Syndrome:
In patients diagnosed with Nephrotic syndrome, the intake of salt, fat and protein must be checked. There should be emphasis on the consumption of dietary fibres that are present in vegetables and fruits.
The intake of protein and fluid should also be monitored, but this solely depends on personal factors such as age, weight and condition of the patient. It is recommended to consult a renal dietician who can guide you appropriately.

1. Sodium/salt intake: The sodium or salt intake must be restricted as it leads to high blood pressure and results in fluid retention in the body, thus causing oedema (build-up of fluids within the body cavities and tissues) in the body. Avoid processed food as it contains a lot of salt.
2. Protein intake: Protein is an essential part of the diet as it helps in the general makeup of the body and development of muscles. The consumption of protein must be kept under check and it is the best to consult your dietician for this. Loss of protein in urine needs to be replaced by class 1 high quality proteins in nephrotic syndrome.
3. Limit fat and cholesterol intake: It is always good to curb on bad cholesterol as it is the reason behind several heart diseases. But, with patients diagnosed with Nephrotic Syndrome, it is highly recommended to avoid food rich in fats. This means staying away from unhealthy fatty meat or junk food.
4. Fluid intake: Fluid intake does not have to be necessarily reduced, but it is always good to consult your doctor for the same.

“You are what you eat”. Nephrotic syndrome can slowly progress to chronic kidney disease if the necessary steps are not taken to curb it in an early stage, and diet control is a major way to do so. If you wish to discuss about any specific problem, you can consult a Nephrologist.

An overactive bladder is marked by problems with one’s bladder storage system that results in sudden urge to urinate. Involuntary and leakage of urine is also a possibility in such a case.

The problem of an overactive bladder arises when the muscles of the bladder contract involuntarily. The conditions contributing to overactive bladder are:

1. Excessive production of urine due to diabetes, poor kidney function or excessive fluid intake
2. Medications that increase urine production by the bladder
3. Acute infections in the urinary tract
4. Abnormalities in the bladder, for instance, bladder stones or tumors
5. Factors hindering bladder outflow such as constipation, enlarged prostate or earlier treatments for incontinence (loss of bladder control)
6. Excessive intake of alcohol or caffeine
7. Decline in one’s cognitive abilities due to factors such as ageing, thus making it hard for the bladder to comprehend the signals it gets from the brain
8. Incomplete emptying of the bladder, leaving only a little storage space for the urine
9. Constipation
10. Neurological disorders

How it can be treated?

1. Behavioral interventions help to manage overactive bladder effectively and without side-effects. They include-
   • Exercises to strengthen one’s urinary sphincter and pelvic floor muscles
   • Maintaining a healthy weight
   • Regulating fluid consumption
   • Planning a schedule for trips to the toilet
   • Employing a catheter to empty the bladder entirely
2. Medications to alleviate the symptoms of incontinence and overactive bladder are-
   • Fesoterodine
   • Mirabegron
   • Darifenacin
   • Solifenacin
   • Trospium
   • Oxybutynin gel
   • Oxybutynin as a skin patch
   • Tolterodine
3. Injecting small doses of Botox (Botulinum toxin), protein-bacteria, directly into the bladder tissues to partially paralyze the bladder muscles, thus delaying urination.
4. Surgery to magnify bladder capacity

However, it is a must that you seek the guidance of a urologist on immediate basis. If you wish to discuss any specific problem, you can consult an urologist.