Treatment of Nephrotic Syndrome

Nephrotic syndrome is a kidney disorder characterized by the excessive loss of protein in the urine, swelling (edema), low blood protein levels, and high cholesterol levels. It is not a disease in itself but a collection of symptoms that indicate damage to the kidneys’ filtering units the glomeruli. Treating nephrotic syndrome requires addressing both the underlying cause and managing its symptoms to prevent long term complications.

The treatment for nephrotic syndrome depends on several factors, including the underlying cause, the severity of symptoms, and how well the patient responds to initial therapy. Some individuals experience a single episode that responds well to treatment, while others may face recurrent or steroid-resistant forms that require long-term care. The ultimate goal of treatment is to reduce protein loss, control symptoms, prevent complications, and preserve kidney function.

What is Nephrotic Syndrome?

Before diving into treatment, it’s important to understand what nephrotic syndrome entails. The condition occurs when the glomeruli are damaged and become leaky, allowing large amounts of protein to escape into the urine (proteinuria). The loss of protein particularly albumin leads to fluid accumulation in body tissues, causing swelling, especially around the eyes, ankles, and feet.

Nephrotic syndrome can be caused by several underlying conditions such as minimal change disease, focal segmental glomerulosclerosis (FSGS), membranous nephropathy, or systemic diseases like diabetes, lupus, and infections. Identifying the cause is essential in tailoring the right treatment plan.

Goals of Treatment

The main objectives of treating nephrotic syndrome are :-

1. To reduce protein loss in urine

2. To manage swelling and associated symptoms

3. To control blood pressure and cholesterol

4. To prevent kidney failure or progression to chronic kidney disease

5. To treat the underlying cause

Treatment of Nephrotic Syndrome

• Corticosteroids

In children, minimal change disease is the most common cause of nephrotic syndrome and often responds well to corticosteroids such as prednisone. Steroids help reduce inflammation in the kidneys and lower protein leakage. Most pediatric patients respond to steroid therapy within weeks, though some may experience relapses and require repeated courses or long-term therapy.

• Immunosuppressive Agents

If corticosteroids are ineffective or cause significant side effects, doctors may prescribe other immunosuppressants such as cyclophosphamide, cyclosporine, tacrolimus, or mycophenolate mofetil. These medications help suppress the immune system and reduce further kidney damage in conditions like FSGS or membranous nephropathy.

• Diuretics

Swelling caused by fluid retention is managed using diuretics such as furosemide or spironolactone. These medications help the body eliminate excess fluid through urine, relieving symptoms of edema and discomfort.

• ACE Inhibitors and ARBs

Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are often prescribed to reduce proteinuria and protect kidney function. These medications also help lower blood pressure, a key factor in managing chronic kidney conditions.

• Statins

Since nephrotic syndrome often leads to high cholesterol levels, statins like atorvastatin or rosuvastatin may be used to reduce the risk of cardiovascular disease.

Lifestyle and Dietary Modifications

Medications alone may not be sufficient in managing nephrotic syndrome. Lifestyle and dietary changes play a crucial role in supporting kidney health and preventing complications.

• Salt Restriction

Limiting salt intake helps control swelling and manage high blood pressure. Patients are advised to avoid processed foods, canned soups, and salty snacks, and to cook with minimal added salt.

• Protein Intake

Although protein is lost in the urine, excessive dietary protein can worsen kidney damage. Patients should follow a balanced diet with moderate protein intake, guided by a dietitian or nephrologist.

• Fluid Management

Patients with significant edema may need to limit fluid intake. However, this should only be done under medical supervision to avoid dehydration or electrolyte imbalance.

• Managing Cholesterol and Blood Sugar

Patients are encouraged to adopt a heart-healthy diet rich in fruits, vegetables, whole grains, and healthy fats. If nephrotic syndrome is caused by diabetes or accompanied by insulin resistance, blood sugar control becomes essential.

Treating the Underlying Cause

Effectively managing nephrotic syndrome often depends on identifying and treating its root cause.

1. In cases of diabetes-related nephropathy, tight blood sugar control using insulin or oral antidiabetic medications is vital.

2. Autoimmune conditions like lupus may require immunosuppressive therapy tailored to the individual’s condition.

3. Infections, such as hepatitis B or C, that trigger nephrotic syndrome should be treated with appropriate antiviral medications.

A kidney biopsy is often performed to determine the exact cause of nephrotic syndrome, especially in adults or cases that do not respond to initial treatment. This helps guide specific therapy.

Managing Relapses and Long-term Monitoring

Nephrotic syndrome can be a chronic condition, especially in children, with frequent relapses. Long-term monitoring and follow-up with a nephrologist are crucial.

Patients may need repeated courses of corticosteroids or other immunosuppressants. Close monitoring of kidney function, protein levels in the urine, blood pressure, and cholesterol is important to track disease progression and adjust treatment as necessary.

Routine vaccinations, such as pneumococcal and influenza vaccines, are also recommended to prevent infections, which can trigger relapses.

Complications and When to Seek Emergency Care

If not properly managed, nephrotic syndrome can lead to complications such as :-

1. Infections due to low immunoglobulin levels

2. Blood clots from increased blood clotting tendency

3. Chronic kidney disease or even kidney failure

4. Malnutrition due to protein loss

Seek immediate medical attention if there is a sudden increase in swelling, difficulty breathing, reduced urine output, fever, or signs of infection.

Conclusion

Nephrotic syndrome is a complex condition requiring a comprehensive treatment approach that includes medications, dietary management, and regular monitoring. With early diagnosis, individualized treatment, and adherence to medical advice, most patients  especially children can manage the condition effectively and maintain a good quality of life. If you or a loved one is experiencing symptoms of nephrotic syndrome, consult a nephrologist promptly to begin a personalized treatment plan.