What is the appropriate supportive care for patients with nephrotic syndrome?
Patients who have edema from nephrotic syndrome require dietary sodium restriction and judicious use of diuretics.
These agents are often needed in combination (site of action in the loop of Henle and distal tubule), and careful monitoring for hyponatremia, hypokalemia, and metabolic alkalosis is mandatory. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can be used to lower blood pressure and reduce urinary protein excretion.
Hypercholesterolemia can be treated with an HMG-CoA reductase inhibitor. Immunization against Streptococcus pneumoniae should be administered to prevent bacterial infections, such as peritonitis. In select cases, prophylactic antibiotics may be necessary.
Careful surveillance for thromboembolic complications and the administration of anticoagulants may be needed in adult patients.
There are tools that can be used to identify patients at higher risk of thromboembolism and in whom prophylactic interventions are warranted. The use of lipid-lowering drugs is usually not needed in patients with treatment-responsive nephrotic syndrome.
In those with refractory disease, statins may reduce but will not normalize the hyperlipidemia.
