Archive for the ‘Nephrotic Syndrome In Child’ Category

Syndrome Of Corticosteroid Therapy Nephrotic

What Is Corticosteroid Therapy For Nephrotic Syndrome?

Nephrotic syndrome is a set of signs or symptoms that may point to kidney problems.

The kidneys are two bean-shaped organs found in the lower back. Each is about the size of a fist. They clean the blood by filtering out excess water and salt and waste products from food. Healthy kidneys keep protein in the blood, which helps the blood soak up water from tissues. But kidneys with damaged filters may leak protein into the urine. As a result, not enough protein is left in the blood to soak up the water. The water then moves from the blood into body tissues and causes swelling.Both children and adults can have nephrotic syndrome. The causes of and treatments for nephrotic syndrome in children are sometimes different from the causes and treatments in adults. For information about nephrotic syndrome in adults, see the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) publication Nephrotic Syndrome in Adults.With good parental and patient education and close outpatient follow-up care, hospitalization is not usually necessary. Hospitalization should be considered if a patient has generalized edema severe enough to cause respiratory distress, if a patient has tense scrotal or labial edema, if he or she has complications (eg, bacterial sepsis, peritonitis, pneumonia, thromboembolism, failure to thrive), or if patient or family compliance with treatment is in doubt.

More Corticosteroid Therapy For Nephrotic Syndrome

Treatment of nephrotic syndrome has changed substantially over the years. Treatment goals are to induce prompt remission (to avoid complications such as infections, thromboses, and tubulointerstitial lesions that may lead to progressive renal dysfunction) and to limit drug-related adverse effects. These efforts should improve or at least maintain the quality of life for patients.Most children with nephrotic syndrome respond to steroids within 10-14 days of the start of therapy, do not suffer long-term renal injury, and have positive outcomes. Starting corticosteroid therapy promptly and managing complications aggressively decreases the frequency of relapse and slows disease progression. Approximately 90% of children with minimal change nephrotic syndrome respond to initial corticosteroid therapy. In contrast, only 20% of children with focal segmental glomerular sclerosis and 7% of those with membranoproliferative glomerulonephritis experience clinical remission with initial corticosteroid therapy. In patients who do not respond to corticosteroid therapy, administration of cytotoxic therapy or cyclosporine may induce remission or alter the disease course.

Major Corticosteroid Therapy For Nephrotic Syndrome:

To diagnose childhood nephrotic syndrome, the doctor may ask for a urine sample to check for protein. The doctor will dip a strip of chemically treated paper into the urine sample. Too much protein in the urine will make the paper change color. Or the doctor may ask for a 24-hour collection of urine for a more precise measurement of the protein and other substances in the urine.The doctor may take a blood sample to see how well the kidneys are removing wastes. Healthy kidneys remove creatinine and urea nitrogen from the blood. If the blood contains high levels of these waste products, some kidney damage may have already occurred. But most children with nephrotic syndrome do not have permanent kidney damage.Specific treatment of nephrotic syndrome depends on the disease’s cause. These are detailed in the chapters specific to each of these. Thus, glucocorticosteroids, such as prednisone, are used for minimal-change nephropathy. In children, relapse after successful use of prednisone or lack of response to prednisone (“resistance”) may be treated by use of rituximab, an antibody against B-cells. Rituximab has also been used in membranous nephropathy in adults. Prednisone and cyclophosphamide are useful in some forms of lupus nephritis. Secondary amyloidosis with nephrotic syndrome may respond to anti-inflammatory treatment of the primary disease.