{"id":164,"date":"2018-04-23T11:46:17","date_gmt":"2018-04-23T11:46:17","guid":{"rendered":"http:\/\/edren.org\/ren\/?page_id=164"},"modified":"2024-04-30T12:29:20","modified_gmt":"2024-04-30T12:29:20","slug":"nephrotic-syndrome","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/handbook\/unithdbk\/individual-kidney-diseases\/nephrotic-syndrome\/","title":{"rendered":"Nephrotic syndrome"},"content":{"rendered":"<h3>Update in 2024<\/h3>\n<p>The text below on this page is now quite old and we plan to update it in the near future.<\/p>\n<p>Our comprehensive unit guidance on the management of Membranous Nephropathy, Minimal Change Disease and FSGS can be downloaded as a pdf here: <a href=\"https:\/\/edren.org\/ren\/wp-content\/uploads\/2024\/04\/Nephrotic-guideline-2024.pdf\">Nephrotic syndrome guidelines 2024<\/a>.<\/p>\n<p>&nbsp;<\/p>\n<h5><strong><span style=\"color: #800000;\">Nephrotic syndrome<\/span><\/strong><\/h5>\n<p>Proteinuria &gt;3g\/day (PCR &gt;300mg\/mmol) is often associated with:<\/p>\n<ul style=\"list-style-type: disc;\">\n<li>salt and water retention apparent as oedema<\/li>\n<li>hypoalbuminaemia<\/li>\n<li>hypercholesterolaemia<\/li>\n<li>heightened susceptibility to infection<\/li>\n<li>increased risk of venous thrombosis<\/li>\n<\/ul>\n<p>Management directed at the cause of proteinuria requires diagnosis (usually by renal biopsy). Specific treatment, usually immunosuppression, is available for some diseases.<\/p>\n<h5><strong><span style=\"color: #993300;\">Complications<\/span><\/strong><\/h5>\n<p><strong><span style=\"color: #993300;\">Oedema<\/span> <\/strong>is controlled by salt restriction and diuretics.<\/p>\n<p><strong><span style=\"color: #993300;\">Blood pressure<\/span><\/strong> should be reduced to 125\/75 or less, using ACE inhibitors and diuretics in first instance.<\/p>\n<p><strong><span style=\"color: #993300;\">Hypercholesterolaemia<\/span><\/strong> usually requires HMG CoA reductase inhibitors if syndrome is lasting.<\/p>\n<p><strong><span style=\"color: #993300;\">Anticoagulation<\/span><\/strong> as a minimum, immobilised patients should receive heparin prophylaxis .<\/p>\n<p><strong><span style=\"color: #993300;\">Infection<\/span> <\/strong>patients with chronic severe nephrotic syndrome should receive Pneumococcal and meningococcal vaccination. Penicillin prophylaxis has not been shown to be beneficial.<\/p>\n<h5><strong><span style=\"color: #993300;\">Diuretic Therapy<\/span><\/strong><\/h5>\n<ul style=\"list-style-type: disc;\">\n<li>Nephrotic patients are often relatively resistant to diuretics, but respond to loop diuretics &#8211; if necessary in high doses. Diuresis is usually enhanced by adding a thiazide such as bendrofluazide or metolazone, and\/or Spironolactone or other distally-acting diuretic.<\/li>\n<li>Monitor therapy by weight, lying and standing blood pressure and general examination (JVP, chest, oedema). A degree of intravascular contraction is inevitable and necessary. Pronounced contraction is signalled by postural drop in blood pressure &gt;20% (or &gt;20\/10) and is potentially dangerous; this is particularly likely to occur if rate of weight loss is greater than 0.5-1.0kg\/day. Greater rates of loss usually require daily observations.<\/li>\n<li>A degree of residual oedema and mild postural hypotension is often the best that can be achieved.<\/li>\n<\/ul>\n<h5><strong><span style=\"color: #993300;\">Treatment protocols<\/span><\/strong><\/h5>\n<p>Sample steroid protocols for minimal change disease\/FSGS<\/p>\n<table style=\"width: 100%; border-collapse: collapse;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"width: 100%; background-color: #e6f7ed;\"><strong><span style=\"font-size: 12pt; color: #993300;\">Regimen for a first episode of MCD-NS in children:<\/span><\/strong><\/p>\n<p><span style=\"font-size: 12pt;\">Prednisolone 60mg\/m<sup>2 <\/sup>daily for 4 weeks<\/span><\/p>\n<p><span style=\"font-size: 12pt;\">Prednisolone 60mg\/m<sup>2<\/sup> alternate days for (4-<\/span><span style=\"font-size: 12pt;\">8 weeks<\/span><span style=\"font-size: 12pt;\">)<\/span><\/p>\n<p><span style=\"font-size: 12pt;\">Then reduce dose by one quarter each fortnight (total 4.5 months)<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"width: 100%; background-color: #e6f7ed;\"><strong><span style=\"font-size: 12pt; color: #993300;\">Regimen for an adult (MCD or FSGS; protocol recognises slower responses):<\/span><\/strong><\/p>\n<p><span style=\"font-size: 12pt;\">Prednisolone 1mg\/kg\/d daily for 8-16 weeks, or 2 weeks after complete remission, (whichever shorter)<\/span><\/p>\n<p><span style=\"font-size: 12pt;\">Prednisolone 1mg\/kg\/d alternate days for 2-4 weeks<\/span><\/p>\n<p><span style=\"font-size: 12pt;\">Tail dose over 3-4 months (first episode)<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong><span style=\"color: #993300;\">REMEMBER TO PRESCRIBE AN H2 BLOCKER (adults and children)<\/span><\/strong><\/p>\n<p>Consider bone protection (see section on <a href=\"http:\/\/edren.org\/ren\/handbook\/unithdbk\/osteoporosis-prevention-on-steroids\/\">osteoporosis prevention on steroids<\/a>)<\/p>\n<p><strong><span style=\"color: #993300;\">Subsequent relapses:<\/span><\/strong> tail more slowly if relapse has been quick; consider leaving on low dose therapy if frequently relapsing.<\/p>\n<p><strong><span style=\"color: #993300;\">Frequently relapsing \/ steroid-resistant \/ steroid-dependent<\/span><\/strong> patients require discussion.<\/p>\n<p>If response is incomplete, remember coagulation \/ lipid disturbances as above and vaccination.<\/p>\n<h5><strong><span style=\"color: #993300;\">Patient information<\/span><\/strong><\/h5>\n<p><a href=\"http:\/\/edren.org\/ren\/edren-info\/nephrotic-syndrome\/\">Nephrotic syndrome<\/a> &#8211; information for patients from <a href=\"http:\/\/edren.org\/ren\/edren-info\/\">EdRenINFO<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #808080; font-size: 12pt;\"><strong>Acknowledgements<\/strong>:\u00a0\u00a0 Richard Phelps was the main author for this page. The 2024 Guidelines on the management of Membranous, Minimal Change and FSGS were written by Ailish Nimmo, Elizabeth Hird and Fiona Duthie.\u00a0 The last modified date is shown in the footer.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Update in 2024 The text below on this page is now quite old and we plan to update it in the near future. Our comprehensive unit guidance on the management of Membranous Nephropathy, Minimal Change Disease and FSGS can be downloaded as a pdf here: Nephrotic syndrome guidelines 2024. &nbsp;\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/handbook\/unithdbk\/individual-kidney-diseases\/nephrotic-syndrome\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":2,"featured_media":0,"parent":5392,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"class_list":["post-164","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/164","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=164"}],"version-history":[{"count":8,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/164\/revisions"}],"predecessor-version":[{"id":6389,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/164\/revisions\/6389"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/5392"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=164"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}