Treatment of Nephrotic Syndrome

Treatments of Nephrotic Syndrome
Treat the complications
Peripheral Edema
• frusemide, spironolactone as diuretics
• CIx – albumin serum level <1.5 g/dL (N-3.4 - 5.4 g/dL)
Protein Loss (Proteinuria)
• dietary protein intake should replace the daily urinary protein losses
• protein restriction to 0.6 - 0.8 g/kg/d shows mild benefit but great care must be taken so there is no malnutrition.
• ACE inhibitors or ARB. (Lisinopril | Losartan [for those unable tolerate ACE I - cough] )
o Reducing blood pressure by reducing intraglomerular pressure and direct action of podocytes (increasing their population)
Hyperlipidemia
• statin (Lovastatin)
• hyperlidpidemia always be there unless nephrotic syndrome is treated
Hypercoagulable State
• serum albumin < 2 g/dL can become hypercoagulable.
• taken by ppl prone to renal vein thrombosis and other tromboemboli but not as primary prevention.
Treat underlying cause
• Systemic Lupus Erythematosus [causes lupus nephritis, autoimmune disease]
o Immunomodulators
 Cyclophosphamide [prodrug - liver]
 Useful for relapse steroid sensitive nephrotic syndrome
• Minimal Change Nephropathy [histopathologic lesion in the glomerulus]
o Corticosteroids
 Prenidisone [prodrug - liver]
• Amyloidosis [extracellular tissue deposition of fibrils composed of fragments of serum amyloid A (SAA) protein.]