Treatment Overview

Treatment for nephrotic syndrome depends on the cause and the age of the person who has the condition. Medicines, changes in diet, and care for other conditions, such as diabetes or high blood pressure, are all possible treatments for this syndrome. These treatments may reverse, slow or prevent further kidney damage.

Most children who have nephrotic syndrome do well with treatment and have a normal life expectancy. Children older than age 12 at the time of diagnosis and adults who also have diabetes or high blood pressure do not respond as well to treatment as do children younger than 12.

Doctors define complete recovery as living without symptoms or treatment for more than 2 years.¹

Initial treatment

Treatment of nephrotic syndrome depends on the cause of the disease and may include:

• Corticosteroids, such as prednisone or prednisolone, to reduce swelling.
• Diuretics, such as bumetanide (Bumex) or furosemide (Lasix), to reduce fluid buildup in the body (edema) and help with reducing sodium, potassium, and water. Fluid reduction should occur slowly to avoid further kidney damage and low blood pressure.
• Medications, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), to reduce the amount of protein lost in the urine, lower blood pressure, and slow the progress of the disease.
• In rare cases, salt-free albumin given through a vein (IV). Albumin helps remove extra fluid from the tissues.

You may need emotional support during treatment for nephrotic syndrome. If you or your child has nephrotic syndrome and you are having a hard time handling treatment or the severity of your child's condition, talking with a doctor or seeking counseling may help.

First treatments can last from 6 to 15 weeks, often longer in adults.⁴ Depending on how severe your symptoms are or whether they return, ongoing treatment may be necessary for months to years, or even the rest of your life.

Ongoing treatment

Ongoing treatment for nephrotic syndrome and complications of the disease include:

• Daily or alternate-day prednisone, if nephrotic syndrome returns.
• Cyclophosphamide, cyclosporine, or CellCept, when treatment with corticosteroids is not successful.
• Steps to lower blood pressure, including medication, a healthier diet, and exercise. Untreated high blood pressure increases your risk for stroke or heart attack. For more information, see the topics High Blood Pressure (Hypertension), Coronary Artery Disease, and Stroke.
• Changes in diet to replace nutrients lost through the urine, reduce fluid buildup in the body, and reduce the risk of complications. Some doctors prescribe a diet that limits protein, salt (sodium), and fats but is high in carbohydrates. The amount of protein allowed may vary, depending on your condition.
• Anticoagulants, such as warfarin (Coumadin) or heparin, to treat blood clots if they form.
• Early treatment of infections with antibiotics.
• Vaccinations with a pneumococcal vaccine(What is a PDF document?) , such as Pneumovax, to prevent infections; chickenpox (varicella) vaccines; and a yearly flu shot. Vaccination is not recommended until nephrotic syndrome has responded to treatment with corticosteroids.^{5, 6}
• Calcium and vitamin D supplements to protect your bones and help prevent osteoporosis during long-term corticosteroid treatment (for example, prednisone).

You can help slow the progression of kidney damage caused by nephrotic syndrome by:

• Keeping blood pressure at less than 125/75 mm Hg with medication, diet, and exercise. For more information, see the topic High Blood Pressure (Hypertension).
• Keeping strict blood glucose control if you have diabetes. For more information, see the topics Type 1 Diabetes and Type 2 Diabetes.
• Maintaining healthy levels of fats (lipids), such as cholesterol and triglycerides. For more information, see the topic High Cholesterol.
• Not smoking or using other tobacco products. For more information, see the topic Quitting Smoking.
• Avoiding medications that may harm the kidneys.
• Avoiding X-ray tests that use contrast material.
• Preventing coronary artery disease. Lifestyle changes such as eating a low-fat diet, quitting smoking, and getting regular exercise can help reduce your overall risk of developing heart disease and stroke. For more information, see the topic Coronary Artery Disease.
• Weighing yourself daily so that you are aware of any rapid weight gain.

You may need emotional support during treatment for nephrotic syndrome. If you or your child has nephrotic syndrome and you are having a hard time handling treatment or the severity of your child's condition, talking with a doctor or seeking counseling may help.

Treatment if the condition gets worse

Sometimes treatment for nephrotic syndrome is unsuccessful. If this occurs, you may develop chronic kidney disease. Your doctor may recommend that you begin hemodialysis, peritoneal dialysis, or consider a kidney transplant. For more information, see the topic Chronic Kidney Disease.

Clinical trials are ongoing to test more effective medicines for the treatment of steroid-resistant (relapsing) nephrotic syndrome. Ask your doctor about clinical trials if treatment has not successfully controlled your nephrotic syndrome. To participate in a clinical trial, you may need to travel to a large treatment center.