How to reduce the complications of MCD
What steps can be taken to reduce the complications of MCD?
The complications of nephrotic syndrome can be avoided by keeping the patient in remission whenever possible.
The risk of some of the infectious complications can be avoided by making sure that patients receive vaccines against all infectious agents that can cause life-threatening infections. All adults and children older than 2 years of age should receive the 23-valent pneumococcal vaccine.
All patients with MCD should receive yearly influenza vaccines. Children should receive their childhood vaccines with deferral of live virus vaccines (measles, mumps, and rubella; varicella) until they are in remission off of immunosuppressive medications. The administration of live virus vaccine may be associated with a relapse, but that risk is minimal when compared with the risk of vaccine-preventable disease.
Adults and children with MCD should also have the status of their immunity against varicella determined by checking a varicella-zoster IgG titer. Varicella infections in individuals who are immune compromised, including those individuals taking prednisone, may be fatal.
If the patient does not have a protective titer against varicella, vaccine should be given if possible. If the patient cannot receive vaccine because of continued immunosuppression, varicella-zoster immune globulin should be administered as soon as possible after exposure to an individual with chicken pox.
If a patient who is immunosuppressed develops chicken pox or zoster, he or she should receive immediate treatment with intravenous acyclovir.
A reduction in thromboembolic complications can be attempted by being vigilant for situations in which thromboembolism is more of a risk, particularly protecting the intravascular volume of a critically ill patient in relapse.
Central venous catheters should be avoided whenever possible in this patient population.
If a patient experiences a thromboembolic event, treatment should include heparin or low-molecular-weight heparin, followed by warfarin for 6 months. Prophylactic anticoagulation therapy should be administered for future relapses in these patients.
Chronic hyperlipidemia, if present, warrants therapy in adults; there are little data on its use in children at this point and should only be considered in children who are chronically hyperlipidemic.
Hypertension is best treated initially with an ACE inhibitor and/or an ARB, which should help reduce the risk of cardiovascular complications later.
