Patient's question:
What are the treatment methods for nephrotic syndrome? What is the best treatment?Doctor's answer:
Hello, Nephrotic syndrome is a group of syndromes caused by various etiologies, characterized by clinical features such as massive proteinuria, hypoproteinemia, edema, and hyperlipidemia. Urinalysis can be used for diagnosis.Guidelines:
1) General therapy
- Rest: During severe edema and hypertension, bed rest is required. Generally, strict activity restriction is not necessary.
- Diet: When hypertension and edema are present, a salt-free or low-salt diet should be provided. Long-term salt restriction is not advisable. In cases of severe edema, fluid intake should be controlled. During high-dose corticosteroid use, vitamin D and calcium supplements should be appropriately administered.
- Prevention and treatment of infection: Pay attention to skin care, avoid public places to prevent cross-infection, and generally do not advocate prophylactic antibiotic use. If infection occurs, active and timely treatment should be given.
- Use of diuretics: In cases sensitive to corticosteroids, diuresis may appear 7–10 days after medication, so diuretics are not needed. However, for severe edema with pleural or abdominal effusion and dyspnea, or for patients temporarily unable to take corticosteroids due to infection, diuretics can be given first to improve overall condition. Generally, hydrochlorothiazide, spironolactone, or triamterene are administered in divided doses orally. Intravenous administration of potent diuretics such as furosemide or ethacrynic acid can rapidly excrete sodium and promote diuresis. For children with significant edema, low-molecular-weight dextran can be given.
2) Corticosteroid therapy
- Short-term therapy: Suitable for initial simple nephrotic syndrome. Prednisone at a dose of 2 mg/kg/day, with a maximum of 60 mg/day, is administered in 3–4 divided doses orally. After urine protein becomes negative, consolidation therapy is continued for 2 weeks. The general course is 4–6 weeks, then changed to 1.4 mg/kg once every other morning for 4–6 weeks, followed by abrupt discontinuation. The total course is 8–12 weeks.
- Medium- and long-term therapy: Prednisone at a dose of 1.5–2.0 mg/kg/day, with a maximum of 60 mg/day, is administered in divided doses. After urine protein becomes negative, consolidation therapy is continued for 2 weeks, generally not exceeding 6–8 weeks. The above dose is then changed to once every other morning, with a dose reduction every 2–4 weeks until discontinuation. The total course is 4–6 months for medium-term therapy, 9–12 months for long-term therapy.