What are the treatments for nephrotic syndrome

Nephrotic syndrome is a relatively common kidney disease. If not treated in time, it may lead to uremia, and the consequences can be imagined. Therefore, when suffering from nephrotic syndrome, we must learn more about the main treatment methods and seek medical treatment as soon as possible to avoid nephrotic syndrome causing greater harm to our health. So, what are the treatments for nephrotic syndrome? Let’s take a closer look below.

1. General treatment

(1) Rest: Patients without severe edema, hypovolemia, or infection do not need to stay in bed. Even if they need to stay in bed, they should change their body position in bed to prevent complications of vascular embolism.

(2) Diet: For cases of edema, a low-salt diet (2g/d) is recommended. For cases of severe edema and hypertension, salt withdrawal is recommended, but it must also be adjusted according to blood sodium levels. Long-term salt withdrawal is not advisable. In patients with reduced GFR, water intake should be restricted. It is difficult to determine the amount of protein intake at present.

(3) Vitamins and minerals: Patients with persistent heavy proteinuria should be supplemented with VitB6. Persistent proteinuria can reduce serum active VitD binding protein, serum 25(OH)D3 and 1,25 (OH)2D3. CS reduces intestinal calcium absorption and promotes renal calcium excretion, leading to disorders in VitD and calcium metabolism in the body. Therefore, patients with persistent NS should be supplemented with VitD 500-10001U/d, or 1,25 (OH)2D3 (rocaltrol) 1.25-2.5μg, orally twice a week, and take calcium supplements at the same time. Blood calcium should be monitored during medication to avoid excessive increases.

(II) Symptomatic treatment

1. Diuretic and detumescent

(1) Thiazide diuretics: They act on the anterior segment of the distal convoluted tubule and induce diuresis by inhibiting the reabsorption of sodium, chloride, and potassium. The commonly used dose of hydrochlorothiazide is 25 to 50 mg, 2 to 3 times a day, which has a diuretic effect on most patients.

(2) Loop diuretics: They mainly act on the ascending limb of the loop of Henle and have a strong inhibitory effect on the reabsorption of sodium, chloride, and potassium. They are strong diuretics and are the first choice diuretics for nephrotic syndrome. Commonly used medications include furosemide 40-120 mg/d or bumetanide (buturonate) 1-3 mg/d, taken orally or intravenously in divided doses.

(3) Potassium-retaining diuretics: They mainly act on the posterior segment of the distal convoluted tubule, excreting sodium and chloride and retaining potassium. Commonly used medications include 50 mg of triamterene, 3 times a day, and 20-40 mg of spironolactone, 3 times a day. The latter is an anti-aldosterone drug, and increased aldosterone is one of the important factors of renal edema, so it is suitable for diuresis in nephrotic syndrome. This type of drug has a weak diuretic effect and is often used in combination with thiazide or loop diuretics to enhance the diuretic effect and reduce electrolyte imbalance.

(4) Osmotic diuretics: sodium-free low-molecular-weight dextran or 706-generation plasma is commonly used for intravenous drip once a day or every other day. The molecular weight of these two drugs is 25,000 to 45,000, which can increase the colloidal osmotic pressure in plasma and promote the reabsorption of water in tissues into the blood. On the other hand, they can be filtered through the glomerulus, forming hyperosmotic pressure in the renal tubules, acting as an osmotic diuretic, and are more suitable for diuresis in nephrotic syndrome. However, they should be used with caution in patients with oliguria (urine volume less than 400 mg/d), because at this time they are prone to form casts together with Tamm-Horsfall protein secreted by the renal tubules and albumin filtered by the glomeruli, blocking the renal tubules. It can also cause degeneration and necrosis of renal tubular epithelial cells through its hyperosmotic effect, inducing "osmotic nephropathy" and leading to acute renal failure.

The above is an introduction to the treatment methods for nephrotic syndrome. I hope it will be helpful to patients. Nephrotic syndrome is a relatively complex type of disease. Although there are many treatment methods, different patients require different treatments. After becoming ill, you must diagnose your condition and then take reasonable treatment measures in order to recover.