What are the recommended first-line treatments for managing nephrotic syndrome in children?

First-line treatment for managing nephrotic syndrome in children is oral corticosteroid therapy, typically using prednisone or prednisolone. This approach aims to induce remission by reducing proteinuria and inflammation in the kidneys. Treatment usually starts with a high-dose corticosteroid regimen, followed by a tapering schedule based on clinical response and remission status. Close monitoring for side effects such as growth suppression, hypertension, and glucose intolerance is essential during therapy.

Oral corticosteroids are preferred because they effectively induce remission in the majority of children with idiopathic nephrotic syndrome. The dosing regimen often involves daily administration initially, with alternate-day dosing considered later to minimize adverse effects on growth and adrenal function. Specialist paediatric input is recommended for prolonged or high-dose corticosteroid use to manage potential complications and adjust treatment accordingly.

In addition to corticosteroids, management includes supportive care such as blood pressure control and monitoring for complications, but corticosteroids remain the cornerstone of first-line therapy. If corticosteroid resistance or frequent relapses occur, referral to a paediatric nephrologist for further evaluation and alternative immunosuppressive therapies may be necessary.

This treatment strategy aligns with UK clinical practice guidelines emphasizing corticosteroids as first-line agents in children, supported by evidence from pharmacotherapeutic reviews highlighting their efficacy in inducing remission in idiopathic nephrotic syndrome.

Summary: Oral corticosteroids (prednisone/prednisolone) are the recommended first-line treatment for nephrotic syndrome in children, with dosing tailored to minimize side effects and specialist oversight advised for prolonged therapy.

References: NICE CKS Hahn et al. 2015