From the FDA Drug Label
To induce a diuresis or remission of proteinuria in the nephrotic syndrome, without uremia, of the idiopathic type or that due to lupus erythematosus
- Nephrotic Syndrome is a condition characterized by
- proteinuria (excess protein in the urine)
- possibly edema (swelling)
- it can be idiopathic (of unknown cause) or due to other conditions such as lupus erythematosus 1
From the Research
Nephrotic syndrome is a kidney disorder characterized by excessive protein loss in the urine, low blood protein levels, high cholesterol, and swelling, and its treatment should be based on the underlying cause, with the most recent and highest quality study 2 suggesting that corticosteroids like prednisone are the mainstay of treatment, especially for steroid-sensitive cases.
Definition and Causes
Nephrotic syndrome occurs when the kidney's filtering units (glomeruli) are damaged, allowing proteins to leak into the urine. The causes can be primary (idiopathic) or secondary, with diabetes mellitus being the most common secondary cause in adults, and focal segmental glomerulosclerosis and membranous nephropathy being the most common primary causes 3.
Symptoms
Common symptoms include:
- Edema (swelling) particularly in the legs, ankles, and around the eyes
- Foamy urine
- Weight gain from fluid retention
- Fatigue
Treatment
Treatment depends on the underlying cause, but typically includes:
- Corticosteroids like prednisone, starting at 1mg/kg/day for adults or 60mg/m² for children for 4-6 weeks, followed by a gradual taper 2
- For steroid-resistant cases, immunosuppressants such as cyclosporine, tacrolimus, or mycophenolate mofetil may be prescribed
- Supportive care includes:
- Diuretics like furosemide (20-80mg daily) to reduce swelling
- ACE inhibitors or ARBs to decrease protein leakage
- Statins for high cholesterol
- A low-sodium diet (less than 2g daily)
Management and Prognosis
Blood pressure control is essential, with a target below 130/80 mmHg. Patients should monitor their weight daily, watch for signs of infection, and have regular follow-up appointments to assess kidney function and medication effectiveness. The prognosis varies based on the underlying cause, response to treatment, and development of complications 2.