From the Guidelines
The key differences in treatment between nephrotic syndrome and nephritic syndrome lie in their distinct pathophysiologies, with nephrotic syndrome focusing on reducing proteinuria and edema, and nephritic syndrome on controlling inflammation and preserving kidney function.
Treatment Approaches
- Nephrotic syndrome treatment primarily involves:
- ACE inhibitors or ARBs to decrease protein excretion
- Diuretics like furosemide (20-80mg daily) to manage fluid retention
- Corticosteroids such as prednisone (1mg/kg/day for 4-16 weeks) for primary forms, particularly minimal change disease, as recommended by 1 and 1
- Immunosuppressants like cyclophosphamide, cyclosporine, or rituximab for steroid-resistant cases
- Nephritic syndrome treatment focuses on:
- Aggressive blood pressure management with multiple antihypertensives
- Immunosuppressive therapy varying by the specific cause, such as cyclophosphamide plus corticosteroids for ANCA-associated vasculitis, or plasma exchange for anti-GBM disease
Supportive Care
- Both syndromes require supportive care including:
- Sodium restriction (2-3g daily)
- Monitoring for complications like thromboembolism in nephrotic syndrome
- Regular assessment of kidney function
Pathophysiological Differences
- Nephrotic syndrome primarily involves podocyte damage causing protein leakage
- Nephritic syndrome involves inflammatory damage to the glomeruli causing hematuria, proteinuria, and often rapid decline in kidney function As noted in 1 and 1, the treatment approach should consider the underlying cause and clinical features, with corticosteroid and immunosuppressive therapy recommended for idiopathic FSGS associated with clinical features of the nephrotic syndrome.
From the Research
Nephrotic vs Nephritic Syndrome: Key Differences in Treatment
The key differences in treatment between nephrotic syndrome and nephritic syndrome are based on the underlying causes and pathophysiology of each condition.
- Nephrotic Syndrome: Treatment typically involves immunosuppressive therapies, such as corticosteroids, cyclosporine, and tacrolimus, to reduce proteinuria and slow disease progression 2, 3, 4, 5.
- Nephritic Syndrome: Treatment is often focused on managing hypertension and reducing proteinuria using angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) 5.
Treatment Approaches
Different treatment approaches have been studied for nephrotic syndrome, including:
- Corticosteroid therapy: Effective in reducing proteinuria and inducing remission in many cases 4.
- Immunosuppressive agents: Such as cyclosporine and tacrolimus, which can be used in combination with corticosteroids to achieve remission 2, 5.
- Combination therapy: Using a combination of corticosteroid, cyclosporine A, and mycophenolate mofetil has shown promise in refractory cases 6.
- Rituximab: Has been used in some cases of refractory nephrotic syndrome, although the evidence is limited 3, 5.
Comparison of Treatment Outcomes
Studies have compared the outcomes of different treatment regimens, including:
- Cyclosporin vs. placebo: Cyclosporin was found to increase the number of participants who achieve complete remission 5.
- CNI vs. IV cyclophosphamide: CNI was found to increase the number of participants with complete or partial remission at 3 to 6 months 5.
- Tacrolimus vs. cyclosporin: Tacrolimus was found to make little or no difference to the number who achieve complete or partial remission 5.