Read Online in English
Table of Content
Preface and Contents

Nephrotic Syndrome

Treatment of Nephrotic Syndrome

CHP. 22. Nephrotic Syndrome 167.

In nephrotic syndrome the goals of treatment are to relieve symptoms, correct urinary loss of protein, prevent and treat complications and protect the kidney. Treatment of this disease usually lasts for a long period (years).

1. Dietary advice

The dietary advice/restriction for a patient with swelling differs once the swelling disappears with effective treatment.

  • In a patient with swelling:Restriction of dietary salt and avoidance of table salt as well as foods that are high in sodium content, so as to prevent fluid accumulation and edema. Restriction of fluid is usually not required.

    Patients receiving high doses of daily steroids should restrict salt intake even in the absence of swelling to decrease the risk of developing hypertension.

    For patients with swelling, adequate amounts of proteins should be provided to replace the urine protein loss and prevent malnutrition.An adequate amount of calories and vitamins should also be provided to these patients.

  • In symptom- free patients:The dietary advice during the symptom- free period is a normal healthy diet. Unnecessary dietary restrictions should be avoided. Avoid restriction of salt and fluid. Provide an adequate amount of proteins. Avoid moderately high protein diets to prevent kidney damage and restrict protein intake in the presence of kidney failure. Increase intake of fruits and vegetables. Reduce the intake of fat in diet to control blood cholesterol levels.
In patients with swelling, salt restriction is necessary but during symptom-free period avoid unnecessary dietary restrictions.
2. Drug therapy
A. Specific drug treatment
  • Steroid therapy: Prednisolone (steroid) is the standard treatment for inducing remission in nephrotic syndrome. Most children respond to this drug. Swelling and protein in the urine disappear within 1-4 weeks (urine free of protein is labeled as a remission).
  • Alternate therapy:A small group of children who do not respond to steroid treatment and continue to lose protein in their urine need further investigation such as a kidney biopsy. Alternate drugs used in such patients are levamisole, cyclophosphamide, cyclosporin, tacrolimus and mycophenylate mofetil (MMF). These alternate drugs are used along with steroid therapy and help to maintain remission when the dose of steroid is tapered.
B. Supportive drug treatment
  • Diuretic drugs to increase urine output and reduce swelling. They should be used only under supervision by a doctor as excessive use may cause kidney failure.
  • Antihypertensive drugs such as ACE inhibitors and angiotensin II receptor blockers to control blood pressure and to reduce the urinary loss of protein.
  • Antibiotics to treat infections (e.g. bacterial sepsis, peritonitis, pneumonia).
  • Statins (simvastatin, atorvastatin, rosuvastatin) to reduce cholesterol and triglycerides and prevent the risk of heart and blood vessel problems.
  • Supplement calcium, vitamin D and zinc.
  • Rabeprazole, pantoprazole, omeprazole or ranitidine for protection against steroid induced stomach irritation.
  • Albumin infusions are generally not used because their effects last only transiently.
  • Blood thinners such as warfarin (Coumadin) or heparin, may be required to treat or prevent clot formation.
3. Treatment of underlying causes

Meticulous treatment of underlying causes of secondary nephrotic syndrome such as diabetic kidney disease, lupus kidney disease, amyloidosis etc. is important. Proper treatment of these disorders is necessary to control nephrotic syndrome.

Prednisolone (steroid) is the standard first line treatment of nephrotic syndrome.