In children with nephrotic syndrome, what is often the first line of treatment?

In children diagnosed with nephrotic syndrome, the first line of treatment typically involves the use of immunosuppressants. This approach is based on the understanding that nephrotic syndrome, particularly in its primary form (such as Minimal Change Disease), is often linked to an underlying immunological dysfunction. Immunosuppressive therapy, commonly with corticosteroids like prednisone, has been shown to reduce proteinuria (the presence of excess protein in urine), control edema, and improve clinical symptoms.

The main goal of initiating immunosuppressive treatment is to target the pathophysiological process involved in nephrotic syndrome, which is driven by glomerular damage and increased permeability to proteins. By suppressing the immune response, these medications help in restoring the normal function of the glomeruli, alleviating symptoms, and preventing complications such as infections and thromboembolic events that can arise from the condition.

While other treatment options may be necessary for managing specific complications or adjunctively supporting the child’s health, such as diuretics for edema management or antibiotics if infections occur, immunosuppressive therapy is considered the cornerstone for addressing the root cause of nephrotic syndrome in pediatric patients.