| Fluids | Nephrotic patients are fluid overloaded. They should therefore be put on a fluid restriction. In addition, their sodium intake should be restricted. | ||
| Infection | An increased risk of
pneumococcal infection means that children are often placed on penicillin
prophylaxis, while they are nephrotic. There is however no evidence of
benefit. Children should be given pneumococcal vaccine when in remission. If varicella zoster non-immune children come in to contact with someone with chickenpox or shingles while on steroids, they should be given zoster immunoglobulin. |
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| Thrombosis risk | A major risk for thrombosis is
hypovolaemia and the associated haemoconcentration. Therefore
correction of hypovolaemia is an important means of preventing thrombosis. Nephrotic patients are often put on aspirin, although the main problem is with the coagulation system and patients at greater risk, with a more chronic nephrotic condition may require anticoagulation. |
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| Oedema | The oedema will resolve once the proteinuria ceases. However if patients are having serious problems due to the oedema e.g. cellulitis develops, then it can be improved by giving 20% albumin (0.5-1 g/kg) + i.v. furosemide. | ||
| Hypertension | The presence of hypertension suggests hypovolaemia and should be treated with 4.5% albumin. | ||
| Drug treatment of nephrotic syndrome | The mainstay of
therapy for childhood nephrotic syndrome is steroids. Children
presenting with uncomplicated primary nephrotic syndrome are given a trial
of steroids, to which 80-90% will respond. Relapses are similarly treated with steroids. Children having frequent relapses, or who are resistant to steroids are given a number of other immunosuppressive agents including levamisole, mycophenolate mofetil, cyclophosphamide and cyclosporin. The anti-CD19 agent rituximab is also becoming an option. |
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