Adult nephrotic syndrome: non-specific strategies for treatment.
Irrespective of aetiology, the nephrotic syndrome presents a range of potentially serious complications. These include thrombo-embolism, infection and hyperlipidaemia. Despite the prevalence of the nephrotic state among renal patients, there has been little prospective analysis of the therapeutic approach to these potentially life-threatening events even though their pathogenesis has been examined in some detail. Most of these complications are more prevalent once the albumin concentration falls below 20 g/L and it is recognized that restoration of serum albumin significantly diminishes their frequency. However, this may be difficult to achieve, especially in adults. The problems of thrombo-embolism and infection are of immediate concern but, in persistent cases, the additional issues of hyperlipidaemia and loss of bone density also require consideration for therapy. Thus, in addition to specific attempts to reduce proteinuria, it is recommended that high-risk nephrotic patients receive anticoagulation, pneumococcal vaccination and lipid lowering therapy. Strategies for the preservation of bone density should also be considered, particularly in patients who receive high-dose corticosteroids. Among a range of non-specific treatments for proteinuria, angiotensin-converting enzyme inhibitors appear best in terms of efficacy and safety. Prospective trials are required to clarify the longitudinal impact of these generic strategies on the protection of the persistently nephrotic patient.
Charlesworth
John A
JA
Department of Nephrology, Prince of Wales Hospital and The University of New South Wales, Sydney, New South Wales, Australia. j.charlesworth@unsw.edu.au
Gracey
David M
DM
Pussell
Bruce A
BA
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001428:Bacterial Vaccines / Q000627:therapeutic use; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007239:Infections / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D009404:Nephrotic Syndrome / Q000150:complications / Q000628:therapy*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011379:Prognosis; D011507:Proteinuria / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D001428:Bacterial Vaccines; D000960:Hypolipidemic Agents