The treatment of nephrotic syndrome will depend on the underlying cause of the syndrome. Therefore, it is important that the most likely cause is identified during the diagnostic process to enable the optimal treatment decisions to be made.
The primary aim of treatment is to reduce symptoms and complications of nephrotic syndrome. This is done with a combination or lifestyle interventions and medications targeted towards specific areas linked to the condition.
Anti-Hypertensive Medications for Blood Pressure
Medications to control blood pressure are often recommended for patients with nephrotic syndrome who have hypertension. This is useful both to reduce blood pressure and minimize the loss of protein in the urine. Common antihypertensive medication options for nephrotic syndrome include:
- Angiotensin-converting enzyme (ACE) inhibitors: benazepril, captopril, enalapril
- Angiotensin II receptor blockers (ARBs): losartan, valsartan
These two classes of drugs are preferable to other antihypertensive medications because they have a direct effect on the function of the kidney and help to reduce the excretion of protein in the urine.
Diuretic Medications for Edema
Diuretic medications, also commonly referred to as water pills, can be useful to reduce the swelling of edema, which is a common symptom of nephrotic syndrome. Examples of diuretic medications that may be used for patients to reduce edema include furosemide and spironolactone.
Statin Medications for Hypercholesterolemia
Medications to reduce the levels of cholesterol may sometimes be recommended for patients with nephrotic syndrome who have high levels of cholesterol in the blood. These medications are thought to help reduce the risk of associated complications, such as a myocardial infarction, although the specific benefits for patients with nephrotic syndrome are not clear.
Examples of statin medications that may be used for patients with nephrotic syndrome include atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin.
Anticoagulant Medications for Blood Clot Prevention
For patients with nephrotic syndrome who are at risk of the formation of blood clots, an anticoagulant medication may be recommended. Examples of blood thinning drugs to reduce clotting factors include warfarin and heparin.
Medications that suppress the immune system can be beneficial for patients with nephrotic syndrome who have symptoms related to inflammation. In particular, patients with associated minimal change disease may find immunosuppressant medications such as corticosteroids useful to manage inflammation.
There are some diet and lifestyle interventions that can be made by patients with nephrotic syndrome to help reduce the severity of symptoms. For example, a low-salt diet is useful to limit fluid retention in the body and thus reduce edema associated with nephrotic syndrome.
It is also important for patients to follow general health recommendations, including a regular physical activity and a healthy diet with high intake of fresh vegetable and low intake of processed foods.
It is important that patients with nephrotic syndrome have access to adequate support throughout and after the treatment. Many medications used in the treatment of nephrotic syndrome, such as anti-hypertensives and diuretics, are used on an ongoing basis and may require dose adjustments in the future.
Regular check-ups should also be carried out to monitor ongoing health. This is particularly important for patients taking immunosuppressant medications, who may require immunizations and monitoring for signs of toxicity. However, all patients should have regular appointments with the medical practitioner.
Reviewed by Susha Cheriyedath, MSc