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NEPHROTIC SYNDROME TREATMENT
Treatment of nephrotic syndrome
The main
concern in all cases is likely to be oedema. This
can be massive: over 10 litres of excess fluid is
not infrequent, and some have over 20 litres, when
a
patient is bed-bound with massively swollen and
weeping legs, distressing genital oedema, and
pitting of the abdominal and sometimes the chest
wall.
Patients
with the nephrotic syndrome are unable to excrete
salt or water normally. Very recommendated to strict
limitation of salt intake, controling a total fluid
intake of no more than 1.5 litres per day for those
who are very oedematous, and perhaps no more than 1
litre per day in the most severe cases. The mouth
can be kept moist using swabs or by sucking boiled
sweets or by sucking ice cube.
Diuretics are the mainstay of oedema removal, with
loop diuretics often the only effective agents. Oral
furosemide,if oral furosemide proves ineffective,
then the addition of oral spironolactone (with
particularly close monitoring of the serum potassium
level) or oral metolazone (with close monitoring to
ensure that it is stopped promptly in the event of
massive diuresis) can be helpful. If these fail then
admission to hospital for bed rest and intravenous
diuretic is required, and some would also give daily
intravenous infusions of concentrated albumin.
A number
of agents, including ACE inhibitors, non-steroidal
anti-inflammatory agents, and ciclosporin, can
reduce proteinuria at the expense of some reduction
in the glomerular filtration rate. These drugs, most
commonly ACE inhibitors, are sometimes used for this
purpose.
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