Treatment of the idiopathic nephrotic syndrome

Most of the paediatric patients presenting with nephrotic syndrome (NS) have a nephrosis (minimal glomerular changes with or without focal lesion NS) and most of them are characterized by a clear-cut steroid response: a complete remission is rapidly obtained with high dose of glucocorticoids. Many of them, however, relapse during or after the treatment's withdrawal. Most often, these patients can be managed for several years with long-term alternate-day steroid therapy. Alkylating agents must be used exclusively when the doses of steroids required result in severe toxicity. In other types of NS (steroid resistant nephrosis, membranous and membranoproliferative glomerulonephritides) the efficiency of drugs is not established. Whatever the cause for the NS, adequate supportive therapy is necessary. The constant aim is to allow the patient a normal physical, school and social activity.