Moderate cases have nephrotic syndrome with or without hematuria. B. Hypoalbuminemia can cause severe edema, ascites, pleural effusions, and hypovolemia with azotemia. When hypovolemia results in hypotension, do riot use furosemide. When decreased renal profusion is contributing to hypertension, establish urine output with furosemide and then consider an albumin infusion. During the third month of therapy, taper the dose by 5 mg every 2 weeks.
Monitor proteinuria daily with an albumin-sensitive dipstick.
If the nephrotic syndrome recurs as the prednisone dosage is tapered, steroid-dependent disease is present. However, attempts should be made to accomplish complete discontinuance of steroids whenever possible. Alkylating agents, such as cyclophosphamide and chlorambucil, may decrease the relapse rate but are associated with significant side effects, including abnormal gonadal function, alopecia, leukopenia, hemorrhagic cystitis, and predisposition to overwhelming infection with varicella or measles. Cyclosporin A is now being examined for use in steroid-dependent or resistant cases. Two consecutive relapses occurring during corticosteroid treatment or within 14 days of its cessation.