CLAIM:
Puffiness around a child’s eyes, especially when it is more noticeable in the morning, can be an early warning sign of kidney disease, such as nephrotic syndrome. Early recognition of this symptom can help in timely diagnosis and treatment.
FACT:
True. Persistent morning puffiness around a child’s eyes can be an early sign of nephrotic syndrome, a kidney disorder where protein leaks into urine, causing fluid buildup in tissues. Experts emphasise that while not all eye swelling indicates kidney problems, early evaluation with urine and blood tests allows timely treatment, which is usually effective and prevents complications.
In a viral reel, Dr Imran Patel, a paediatrician with over 1 crore followers on Instagram, has posted a video highlighting a lesser-known early sign of kidney disease in children: persistent puffiness around the eyes.
In the reel, Dr Imran presents the case of a six-year-old child sitting beside him and draws viewers’ attention to the visible swelling on the child’s face. “Hello everybody, this is our 6-year-old hero,” he says, pointing to the puffiness around the boy’s eyes. He explains that the swelling is “more in the morning when he wakes up” and tends to reduce by evening, a pattern that often raises suspicion of an underlying kidney problem.
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Dr Imran then explains, in simple terms, how the kidneys function as filters for the body. “The kidney that we have works as a filter,” he says, adding that while waste products are supposed to leave the body through urine, essential substances like protein should remain in the blood. In this case, he explains, damage to the kidney’s filtering system caused protein to leak into the urine, leading to low protein levels in the body and visible swelling, particularly around the eyes and face.
Identifying the condition as “nephrotic syndrome,” Dr Imran reassures viewers that with timely diagnosis and treatment, usually lasting six to seven weeks, most children recover well. He adds that some children may experience repeat episodes, but these tend to reduce as they grow older.
The reel has gained over 1.5 million views, 49,000 likes, and 6,456 shares, prompting widespread discussion among parents about early warning signs of kidney disease in children.
What is nephrotic syndrome?
Nephrotic syndrome is not a single disease but a group of symptoms that signal a problem with how the kidneys are functioning. It occurs when the kidneys’ filtering units begin to leak essential proteins into the urine instead of retaining them in the blood. As a result, children develop a characteristic set of symptoms including excessive protein in the urine (proteinuria), low levels of albumin in the blood (hypoalbuminemia), swelling in different parts of the body (oedema), and increased levels of cholesterol and other fats in the blood (hyperlipidemia).
The kidneys contain about a million tiny filtering units called nephrons. Each nephron has a glomerulus, which filters the blood, and a tubule, which returns needed substances back to the bloodstream while removing waste and excess water through urine. Nephrotic syndrome usually develops when the glomeruli are damaged, allowing large amounts of protein to escape into the urine.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), “Nephrotic syndrome is not very common in children. On average, fewer than 5 in 100,000 children worldwide develop nephrotic syndrome each year.”
Who does it affect and why?
Nephrotic syndrome can affect children of all ages, but it is most commonly seen between the ages of 2 and 7 years, particularly in boys. In children, the condition is most often caused by diseases that directly affect the kidney’s filtering system, although infections, medications, genetic conditions, and systemic diseases can also play a role.
Primary nephrotic syndrome arises from kidney-specific diseases. The most common cause in young children is minimal change disease (MCD), where damage to the glomeruli is only visible under an electron microscope. Other causes include focal segmental glomerulosclerosis (FSGS), which involves scarring of the glomeruli, and membranous nephropathy, an autoimmune condition that thickens the kidney’s filtering membrane.
Secondary nephrotic syndrome occurs when kidney damage is linked to broader conditions such as lupus, IgA vasculitis, infections like hepatitis B, hepatitis C, HIV, malaria, or certain blood disorders. In rare cases, nephrotic syndrome may be congenital, appearing in infancy due to genetic mutations or infections acquired before birth.
What are the signs and possible complications?
Swelling around the eyes is the most common and often the earliest sign of nephrotic syndrome in children. The swelling is usually more noticeable in the morning and may be mistaken for allergies in mild cases. As the condition progresses, swelling can also appear in the legs, feet, abdomen, hands, and face.
Other common symptoms include foamy urine due to excess protein, fatigue, and reduced appetite. Some children may experience blood in the urine, muscle cramps, diarrhoea, or nausea.
Losing large amounts of protein through urine can lead to serious complications. These include a higher risk of infections, blood clots, high blood pressure, elevated cholesterol levels, and short- or long-term kidney problems. Because protein plays a crucial role in maintaining fluid balance and immune function, its loss affects multiple systems in the body.
How is nephrotic syndrome diagnosed and treated?
Doctors diagnose nephrotic syndrome through a combination of medical history, physical examination, urine tests to detect protein loss, and blood tests to assess kidney function and underlying causes. In some cases, additional investigations such as kidney ultrasounds, genetic testing, or a kidney biopsy may be required. However, many children do not need a biopsy unless the disease is complex, kidney function is reduced, or the child is older than 12 years.
Treatment depends on the type and cause of nephrotic syndrome. In most children with primary nephrotic syndrome, corticosteroids are the first line of treatment. These medicines suppress immune activity, reduce protein leakage, and decrease swelling. Many children go into remission with steroid treatment, although relapses can occur. Importantly, relapses tend to become less frequent as children grow older.
If steroids are ineffective or cause significant side effects, doctors may prescribe other immunosuppressant medications. Additional treatments focus on managing symptoms and preventing complications, such as diuretics to reduce swelling, blood pressure medicines to limit protein loss, statins to control cholesterol, and blood thinners if clots develop.
Children with nephrotic syndrome are also advised to stay up to date with vaccinations, particularly against pneumococcal infections and influenza, due to their increased susceptibility to infections. Dietary changes, such as reducing salt intake and limiting fluids, may also be recommended depending on the child’s condition.
What experts say
Dr Amit Gupta, Senior Neonatologist and Paediatrician at Motherhood Hospitals, Noida, emphasised that persistent puffiness around a child’s eyes, especially noticeable in the morning, can be an early sign of nephrotic syndrome, though “it is not the only possible cause.” He said, “This happens because protein leaks into the urine, lowering protein levels in the blood. As a result, fluid collects in soft tissues, causing swelling around the eyes and face.”
He advised parents to watch for red flags such as “daily or persistent puffiness, frothy urine, swelling of the legs or abdomen, sudden weight gain, or reduced urine output.” According to Dr Gupta, diagnosis is straightforward. “Simple urine and blood tests can confirm nephrotic syndrome,” he said.
Regarding treatment, he noted that “most children respond well, often with steroids, and with timely care, the condition is largely treatable. Relapses usually reduce as the child grows.”
“A low-salt diet, balanced nutrition, infection prevention, and regular follow-ups make a significant difference,” he said, emphasising the importance of supportive care.
Dr Gupta concluded that “occasional puffy eyes are common, but persistent swelling in the morning should always be medically evaluated. Early diagnosis leads to excellent outcomes.”
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.