From the Guidelines
Treatment of nephritic syndrome should focus on addressing the underlying cause, with a target of complete response by 12 months, and may involve the use of glucocorticoids, calcineurin inhibitors, and immunosuppressants like mycophenolate mofetil or cyclophosphamide, as recommended by the 2019 EULAR/ERA-EDTA guidelines 1. The management approach depends on the specific cause of nephritic syndrome, such as lupus nephritis, which requires a multidisciplinary treatment strategy. Key aspects of treatment include:
- Initial induction treatment with mycophenolate mofetil (MMF 2–3 g/day) or low-dose intravenous cyclophosphamide (CY; 500 mg × 6 biweekly doses), combined with glucocorticoids (pulses of intravenous methylprednisolone, then oral prednisone 0.3–0.5 mg/kg/day) for active proliferative lupus nephritis 1.
- The use of hydroxychloroquine with regular ophthalmological monitoring is also recommended 1.
- For patients with nephrotic-range proteinuria and adverse prognostic factors, MMF/CNI (especially tacrolimus) combination and high-dose CY are alternatives 1.
- Long-term maintenance treatment with MMF or azathioprine should follow, with no or low-dose (<7.5 mg/day) glucocorticoids, depending on the initial regimen and plans for pregnancy 1.
- In non-responding disease, switching induction regimens or using rituximab are recommended options 1.
- Assessment for kidney and extra-renal disease activity, and management of comorbidities, is crucial throughout the treatment process 1.
From the Research
Nephritic Syndrome Treatment
- The treatment of nephritic syndrome depends on the underlying cause, with options including corticosteroids, immunosuppressive agents, and other medications 2, 3, 4, 5, 6.
- For lupus nephritis, a common cause of nephritic syndrome, treatment may involve induction immunosuppression regimens of corticosteroids and either cyclophosphamide or mycophenolate mofetil 2, 3, 5.
- Calcineurin inhibitors may also be used in the treatment of lupus nephritis, particularly in patients with heavy proteinuria or refractory disease 2.
- In patients with minimal change nephrotic syndrome, steroids are often effective in inducing remission, while cyclophosphamide or cyclosporine may be used in steroid-resistant cases 4.
- Maintenance therapies for proliferative lupus nephritis may include mycophenolate mofetil, azathioprine, or intravenous cyclophosphamide, with the goal of reducing the risk of chronic renal failure and other complications 5.
- In adults with nephrotic syndrome, treatment may involve fluid and sodium restriction, diuretics, and angiotensin-converting enzyme inhibitors, with corticosteroids used in some cases 6.
Treatment Options
- Corticosteroids: effective in inducing remission in minimal change nephrotic syndrome and lupus nephritis 2, 3, 4.
- Immunosuppressive agents: such as cyclophosphamide, mycophenolate mofetil, and azathioprine, used in the treatment of lupus nephritis and other causes of nephritic syndrome 2, 3, 5.
- Calcineurin inhibitors: may be used in the treatment of lupus nephritis, particularly in patients with heavy proteinuria or refractory disease 2.
- Diuretics: used to manage edema and hypertension in patients with nephrotic syndrome 6.
- Angiotensin-converting enzyme inhibitors: used to reduce proteinuria and slow the progression of renal disease 6.