What is the treatment for fairness cream induced nephrotic syndrome?

Treatment for Fairness Cream Induced Nephrotic Syndrome

The treatment for fairness cream induced nephrotic syndrome should include immediate discontinuation of the mercury-containing cream, followed by high-dose glucocorticoids for 8-12 weeks, with consideration of chelation therapy with sodium dimercaptosulfonate in cases of confirmed mercury toxicity. 1, 2

Initial Management

• Discontinue all fairness creams immediately as they may contain mercury which is the causative agent for the nephrotic syndrome 1, 2
• Obtain blood and urine mercury levels to confirm mercury toxicity and establish baseline values for monitoring 1, 3
• Perform a kidney biopsy to determine the histological pattern, which is typically minimal change disease or membranous nephropathy in fairness cream induced nephrotic syndrome 1, 3, 2
• Start high-dose glucocorticoids (prednisone or prednisolone) at 1 mg/kg/day (maximum 80 mg) for initial treatment 4, 5

Specific Treatment Based on Histological Findings

For Minimal Change Disease (MCD)

• Administer high-dose glucocorticoids for a total of 8-12 weeks instead of the previously recommended 24 weeks (Grade 1B) 4
• Continue high-dose glucocorticoids until complete remission is achieved, then taper slowly over 6 months 4
• For steroid-resistant cases, consider calcineurin inhibitors (CNIs) as second-line therapy:
  • Cyclosporine: 3-5 mg/kg/day in divided doses (target trough level: 100-175 ng/ml) 4
  • Tacrolimus: 0.05-0.1 mg/kg/day in divided doses (target trough level: 5-10 ng/ml) 4

For Membranous Nephropathy (MN)

• For NELL-1 positive membranous nephropathy (common in mercury-induced cases), consider modified Ponticelli regimen 3
• If there is no response to glucocorticoids after 4-6 months, initiate calcineurin inhibitors for at least 6 months 4

Chelation Therapy

• For confirmed mercury toxicity, administer sodium dimercaptosulfonate as chelation therapy alongside immunosuppressive treatment 1
• Continue chelation until blood and urinary mercury levels return to normal range 1, 2

Supportive Care

• Implement fluid and sodium restriction to manage edema 6
• Administer diuretics (loop diuretics preferred) for edema control 6, 7
• Start angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) to reduce proteinuria 6, 7
• Monitor for potential complications such as venous thromboembolism, infections, and hyperlipidemia 6

Monitoring and Follow-up

• Regularly monitor proteinuria, serum albumin, renal function, and mercury levels 1, 3
• Continue treatment until complete remission of proteinuria is achieved and mercury levels normalize 1, 2
• Follow up for at least 6-12 months after discontinuation of the fairness cream to ensure complete resolution 1, 2

Treatment Duration and Expected Outcomes

• Most patients show improvement within 6-9 months after discontinuing the mercury-containing cream and receiving appropriate treatment 1, 2
• Complete remission is typically achieved when both the nephrotic syndrome resolves and mercury levels normalize 1, 3

Special Considerations

• For patients with steroid-dependent or frequently relapsing nephrotic syndrome, consider steroid-sparing agents such as mycophenolate mofetil, rituximab, or cyclophosphamide 4, 8
• In cases of acute kidney injury, provide appropriate renal replacement therapy while continuing immunosuppressive treatment 4
• Consider genetic testing in steroid-resistant cases to rule out genetic causes of nephrotic syndrome 4