Pharmacotherapy/Treatment Of Nephrotic Syndrome

Nephrotic Syndrome

Nephrotic syndrome is a kidney disorder that makes your body pass excess protein in your urine. It is usually caused by damage to the glomeruli of the kidney. The glomerular is known to filter waste and excess water from the blood.

Read Also: Treatment of Glomerulonephritis

This disease condition affects people of all ages. It is more in men than in women. It is more genetic when it affects children less than three months of age.

Symptoms

1. Swelling in feet, ankles and around the eyes due to excess fluid in the body

2. Foaming urine due to the presence of excess protein

3. Sudden weight gain due to fluid retention

4. Fatigue

5. Loss of appetite

6. Anemia

Complication

Loss of protein such as albumin that prevents blood clots leads to clotting of the blood. Also nephrotic syndrome can lead to other diseases such as hypertension and diabetes. Due to the loss of immunoglobulin G (IgG), the person is prone to infection.

Cause

1. Diabetes

2. Minimal change disease results in abnormal kidney function

3. Focal segmented glomerulosclerosis

4. Membranous nephropathy

5. Systemic lupus erythematosus

6. Amyloidosis

Risks Factors

1. Drugs like non steroidal anti-inflammatory agents

2. Infection like human immunodeficiency virus, hepatitis B and C and malaria

3. Diseases such as diabetes

Diagnosis

1. Urine test to detect the presence of albumin. A dipstick urine test that shows >30mg of albumin/g of creatinine indicates nephrotic syndrome

2. Blood test to measure cholesterol and blood triglycerides levels.

3. Kidney biopsy

Pathophysiology

In nephrotic syndrome, the glomeruli are affected by an inflammation or a hyalinization (the formation of a homogenous crystalline material within cells) that allows proteins such as albumin, antithrombin or the immunoglobulins to pass through the cell membrane and appear in urine.

Albumin is the main protein in the blood that is able to maintain an oncotic pressure, which prevents the leakage of fluid into the extracellular medium and the subsequent formation of edemas.

As a response to hypoproteinemia the liver commences a compensatory mechanism involving the synthesis of proteins, such as alpha-2 macroglobulin and lipoproteins. An increase in the latter can cause the hyperlipidemia associated with this syndrome.

Pharmacotherapy/Treatment

Nephrotic syndrome is not a disease. Treatment is focused on the cause of the symptoms. When hypertension is suspected, Angiotensin converting enzyme inhibitors (ACEI), Angiotensin receptor blocker (ARB) and diuretic are used. Examples are lisinopril 5-10mg daily for ACEI, losartan 25-100mg daily and hydrochlorothiazide 25mg daily for diuretic especially when edema is present. Loop diuretics like furosemide are the recommended options for diuretics. Statins are used to thin blood in hyperlipidemia although their usefulness is not very clear. An example is simvastatin 20-40mg daily. Thrombophilia is treated with heparin for 5 days with the use of other oral anticoagulants. Corticosteroids like prednisolone 60mg/m² of a body surface area/day are used for 4-8 weeks as first treatment. Then another 40mg/m² of a body surface area/day for 4 weeks. Relapse is treated with 2mg/kg/day until urine becomes negative for protein. Then 1.5 mg for 4 weeks. The usefulness of corticosteroids is that they decrease proteinuria, infection and oedema. Immune suppressors also play a vital role in the management of nephrotic syndrome. An example is cyclophosphamide. They are used in recurring nephrotic syndrome in corticosteroids dependent or intolerant people. Immunosuppressants are only used when there is no protein and after use of corticosteroids. 3mg/kg/day for 8 weeks. Contraindicated in neutropenia and anemia. Side effects are alopecia.

Read Also: Treatment of worm infection

Lifestyle Modification

1. Less protein

2. Reduce fat food and cholesterol

3. Reduce salt intake

4. Drop down on fluid quantity