What are the treatments for nephrotic syndrome in children?

Kidney disease is a relatively serious disease. Once it occurs in a child with low immunity, the consequences can be imagined. Nephrotic syndrome in children is a disease caused by increased glomerular permeability due to various factors, resulting in large amounts of protein being lost in the urine. Parents are very concerned about the treatment of this disease. So, what are the treatments for nephrotic syndrome in children? Let’s take a closer look below.

(1) Thiazide diuretics mainly act on the thick-walled segment of the ascending limb of the loop of Henle and the anterior segment of the distal convoluted tubule, inhibiting the reabsorption of sodium and chloride and increasing potassium excretion, thereby causing diuresis. Long-term use should prevent hypokalemia and hyponatremia.

(2) Potassium-retaining diuretics mainly act on the posterior segment of the distal convoluted tubule, excreting sodium and chloride but retaining potassium. They are suitable for patients with hypokalemia. When used alone, the diuretic effect is not significant and can be used in combination with thiazide diuretics. Triamterene or the aldosterone antagonist spironolactone are commonly used. Long-term use requires prevention of hyperkalemia and should be used with caution in patients with renal insufficiency.

(3) Loop diuretics act mainly on the ascending limb of the loop of Henle and have a strong inhibitory effect on the reabsorption of sodium, chloride and potassium. Furosemide (Lasix) or bumetanide (Buturoxil) (40 times more potent than furosemide at the same dose) are commonly used, taken orally or intravenously in divided doses. The effect is better when it is given immediately after the use of osmotic diuretics. When using loop diuretics, caution should be exercised to prevent hyponatremia, hypokalemia, and hypochloremia-induced alkali poisoning.

(4) Osmotic diuretics transiently increase plasma colloidal osmotic pressure, allowing water in tissues to be reabsorbed into the blood. In addition, they are filtered through the glomerulus, causing a hyperosmotic state in the renal tubular fluid, reducing the reabsorption of water and sodium and causing diuresis. Sodium-free dextran 40 (low molecular weight dextran) or starch plasma substitute (706 plasma) (molecular weight is 25,000 to 45,000) is commonly used for intravenous drip. Subsequent addition of a loop diuretic can enhance the diuretic effect. However, this type of drug should be used with caution in patients with oliguria (urine volume <400ml/d), because they easily form casts together with Tamm-Horsfall protein secreted by the renal tubules and albumin filtered by the glomeruli, blocking the renal tubules. Their hyperosmotic effect can cause degeneration and necrosis of renal tubular epithelial cells, inducing "osmotic nephropathy" and leading to acute renal failure.

(5) Increasing plasma colloid osmotic pressure. Intravenous infusion of plasma or plasma albumin can increase plasma colloid osmotic pressure, promote water reabsorption in tissues and promote diuresis. For example, if furosemide is added to glucose solution and slowly dripped intravenously, a good diuretic effect can sometimes be achieved. However, since the injected protein will be excreted in the urine within 24 to 48 hours, it can cause glomerular hyperfiltration and tubular hypermetabolism, resulting in damage to the glomerular visceral and tubular epithelial cells and promote renal interstitial fibrosis. In mild cases, it can affect the efficacy of glucocorticoids and delay disease remission, while in severe cases, it can damage renal function. Therefore, the indications should be strictly followed. For NS patients with severe hypoproteinemia, severe edema and oliguria (urine volume <400 ml/d), its use should only be considered when diuresis is necessary, but excessive and frequent use should also be avoided. It should be used with caution in patients with heart failure.

The principle of diuretic treatment for NS patients is not to be too fast or too strong, so as to avoid insufficient blood volume, aggravating the tendency of blood hypercoagulability, and inducing thrombosis and embolic complications.

The above is an introduction to the treatments for nephrotic syndrome in children. I hope it will be helpful to parents. The more typical symptom of nephrotic syndrome in children is swelling of the whole body. When you find that your child has similar symptoms, it is best to pay enough attention to it, go to a regular hospital for diagnosis, and find out the child's condition so that better treatment can be provided.