Topic: Childhood Nephrotic Syndrome
Question: What are the treatments for Childhood Nephrotic Syndrome ?
Answer: Health care providers will decide how to treat childhood nephrotic syndrome based on the type:
                
- primary childhood nephrotic syndrome: medications  - secondary childhood nephrotic syndrome: treat the underlying illness or disease  - congenital nephrotic syndrome: medications, surgery to remove one or both kidneys, and transplantation
                
Primary Childhood Nephrotic Syndrome
                
Health care providers treat idiopathic childhood nephrotic syndrome with several types of medications that control the immune system, remove extra fluid, and lower blood pressure.
                
- Control the immune system. Corticosteroids are a group of medications that reduce the activity of the immune system, decrease the amount of albumin lost in the urine, and decrease swelling. Health care providers commonly use prednisone or a related corticosteroid to treat idiopathic childhood nephrotic syndrome. About 90 percent of children achieve remission with daily corticosteroids for 6 weeks and then a slightly smaller dose every other day for 6 weeks.2 Remission is a period when the child is symptom-free.  Many children relapse after initial therapy, and health care providers treat them with a shorter course of corticosteroids until the disease goes into remission again. Children may have multiple relapses; however, they most often recover without long-term kidney damage.  When a child has frequent relapses or does not respond to treatment, a health care provider may prescribe other medications that reduce the activity of the immune system. These medications prevent the body from making antibodies that can damage kidney tissues. They include      - cyclophosphamide    - mycophenolate (CellCept, Myfortic)    - cyclosporine    - tacrolimus (Hecoria, Prograf)   A health care provider may use these other immune system medications with corticosteroids or in place of corticosteroids.  - Remove extra fluid. A health care provider may prescribe a diuretic, a medication that helps the kidneys remove extra fluid from the blood. Removing the extra fluid can often help to lower blood pressure.  - Lower blood pressure. Some children with childhood nephrotic syndrome develop high blood pressure and may need to take additional medications to lower their blood pressure. Two types of blood pressure-lowering medications, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have the additional benefit of slowing the progression of kidney disease. Many children with nephrotic syndrome require two or more medications to control their blood pressure.
                
Secondary Childhood Nephrotic Syndrome
                
Health care providers treat secondary childhood nephrotic syndrome by treating the underlying cause of the primary illness. For example, a health care provider may treat children by
                
- prescribing antibiotics for an infection  - adjusting medications to treat lupus, HIV, or diabetes  - changing or stopping medications that are known to cause secondary childhood nephrotic syndrome
                
While treating the underlying cause, the health care provider will also treat the child to improve or restore kidney function with the same medications used to treat primary childhood nephrotic syndrome.
                
Caretakers should make sure that children take all prescribed medications and follow the treatment plan recommended by their health care provider.
                
More information about specific treatments for secondary childhood nephrotic syndrome is provided in the NIDDK health topic, Glomerular Diseases.
                
Congenital Nephrotic Syndrome
                
Researchers have found that medications are not effective in treating congenital nephrotic syndrome, and that most children will need a kidney transplant by the time they are 2 or 3 years old. A kidney transplant is surgery to place a healthy kidney from someone who has just died or a living donor, most often a family member, into a persons body to take over the job of the failing kidney. To keep the child healthy until the transplant, the health care provider may recommend the following:
                
- albumin injections to make up for the albumin lost in urine  - diuretics to help remove extra fluid that causes swelling  - antibiotics to treat the first signs of infection  - growth hormones to promote growth and help bones mature  - removal of one or both kidneys to decrease the loss of albumin in the urine  - dialysis to artificially filter wastes from the blood if the kidneys fail
                
More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure in Children.
Source: NIDDK