Management of nephrotic syndrome

1. Mr. Kanhaiya Sah
2nd year student NGMC

2. OBJECTIVES
 To briefly review the definition & etiology of nephrotic syndrome.
 To understand the terminology pertaining to clinical course of
nephrotic syndrome.
 To understand the management of nephrotic syndrome:
Specific management
Supportive care and management of complications.

3. Definition

5. SPECIFIC MANAGEMENT

6. EVALUATION AT ONSET
 Essential investigations: Urinalysis:
Proteinuria, red cells, casts; Spot urine protein creatinine ratio. Blood levels
of urea, creatinine, albumin, cholesterol Complete blood count.
Tuberculin test
 If required:
C3 and ASO tires (gross or persistent microscopic hematuria). Chest X-ray
(positive tuberculin test, history of TB contact). HIV, HBV, HCV
serology in highrisk groups. ANA (if features of SLE
are present). Urine culture (if clinical
features of UTI are present). USG abdomen (to ruleout
anomalies in kidney)

7. INDICATIONS FOR RENAL
BIOPSY
 At Onset (If cause other than minimal change nephrotic syndrome is suspected)
 Age of onset <I year.
 Gross hematuria, persistent microscopic hematuria or low serum C3
 Sustained hypertension.
 Renal failure not attributable to hypovolemia.
 Suspected secondary causes of nephrotic syndrome.
 After Initial Treatment
 Proteinuria persisting despite 4-weeks of daily corticosteroid therapy - steroid
resistance.
 Before treatment with Cyclosporin A or Tacrolimus.

8. MANAGEMENT OF THE INITIAL
EPISODE
 Appropriate therapy at the first episode is an important
determinant of the long term course of the disease.
 Prednisolone is the drug of choice.
 It is given at a dose of 2 mg/kg per day (maximum 60 mg in single
or divided doses) for 6 weeks, followed by 1.5 mg/kg (maximum 40
mg) as a single morning dose on alternate days for the next 6
weeks; therapy is then discontinued.

10. DIETARY MANAGEMENT
 A balanced diet, adequate in protein (1.5-2 g/kg) and calories is
recommended.
 Patients with persistent proteinuria should receive 2-2.5 g/kg of protein
daily.
 Not more than 30% calories should be derived from fat.
 Treatment with corticosteroids stimulates appetite, so adequate physical
activity is to be ensured to prevent excessive weight gain.
 Patients on prolonged (>3 months) treatment with steroids should
receive daily supplements of oral calcium (250-500 mg/day) and vitamin
D (125-250
IU/day).