Proteinuria >3g/day (PCR >300mg/mmol) is often associated with:

Management directed at the cause of proteinuria requires diagnosis (usually by renal biopsy). Specific treatment, usually immunosuppression, is available for some diseases.


Complications

Oedema is controlled by salt restriction and diuretics.

Blood pressure should be reduced to 125/75 or less, using ACE inhibitors and diuretics in first instance.

Hypercholesterolaemia usually requires HMG CoA reductase inhibitors if syndrome is lasting.

Anticoagulation as a minimum, immobilised patients should receive heparin prophylaxis .

Infection patients with chronic severe nephrotic syndrome should receive Pneumococcal and meningococcal vaccination. Penicillin prophylaxis has not been shown to be beneficial. 


Diuretic Therapy


Treatment protocols

Sample steroid protocols for minimal change disease/FSGS

Regimen for a first episode of MCD-NS in children:

Prednisolone 60mg/m2 daily for 4 weeks

Prednisolone 60mg/m2 alternate days for (4-)8 weeks

Then reduce dose by one quarter each fortnight (total 4.5 months)

 

Regimen for an adult (MCD or FSGS; protocol recognises slower responses):

Prednisolone 1mg/kg/d daily for 8-16 weeks, or 2 weeks after complete remission, (whichever shorter)

Prednisolone 1mg/kg/d alternate days for 2-4 weeks

Tail dose over 3-4 months (first episode)

 

REMEMBER TO PRESCRIBE AN H2 BLOCKER (adults and children)

Consider bone protection (see section on osteoporosis prevention on steroids).

Subsequent relapses: tail more slowly if relapse has been quick; consider leaving on low dose therapy if frequently relapsing.

Frequently relapsing / steroid-resistant / steroid-dependent patients require discussion.

If response is incomplete, remember coagulation/ lipid disturbances as above and vaccination.


Patient information

Nephrotic syndrome - information for patients from EdRenINFO

 

 

Acknowledgements:   Richard Phelps was the main author for this page. The last modified date is shown in the footer.

 

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