Topic: pyelonephritis, renal failure, nephrotic syndrome
Question: Discuss the management of first episode of nephrotic syndrome.
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Goals of treatment:
– Induce remission of proteinuria
– Prevent complications like infections, thromboembolism
– Preserve renal function
Medications:
1. Corticosteroids:
– First line for initial episode
– Prednisolone 2 mg/kg/day (maximum 60 mg/day) in divided doses for 4-6 weeks followed by tapered doses over 2-5 months
– Causes remission in 80-90% of patients
2. Albumin infusions:
– Given for severe hypoalbuminemia <2 g/dl
– Dose: 1-2 g/kg of 20% albumin solution over 2-4 hours
3. Diuretics:
– Furosemide 1-2 mg/kg/dose if edema compromises respiratory function
– Spironolactone 1-3 mg/kg/day for refractory edema
4. ACE inhibitors:
– Eg. Enalapril 0.1-0.6 mg/kg/day in divided doses
– Help control proteinuria and hypertension
5. Antibiotics:
– For secondary infections
– Penicillin prophylaxis if serum albumin <2 g/dl
6. Anticoagulants:
– Low molecular weight heparin for high risk of thrombosis
Monitoring:
– Urine protein excretion
– Serum albumin
– Cholesterol levels
– Renal function periodically
Most children (>90%) respond to corticosteroid therapy for first episode of nephrotic syndrome. Non-responders may need kidney biopsy and second-line immunosuppressants like levamisole, cyclophosphamide.
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