Abstract
SUMMARY: Nephrotic Syndrome that fails to respond to specific treatment presents a major therapeutic conundrum. Management strategies aim to normalize glomerular filtration barrier dysfunction, optimize intrarenal haemodynamics to limit stress on capillary walls and limit adverse signalling profiles in the tubulo‐interstitial compartment. Angiotensin converting enzyme (ACE) inhibitors are currently the only proven therapeutic option for patients with Nephrotic Syndrome, although several other agents have demonstrated potential. However, these therapies have not been evaluated in well‐designed trials and their efficacy is largely untested. the angiotensin‐II receptor (All) antagonists, that interrupt the renin‐angiotensin cascade at a different point to ACE inhibitors, may also have renoprotective effects although few long‐term data are available. the efficacy of another class of antihypertensive drugs, the calcium channel blockers, is unclear, perhaps because of the pharmacological heterogeneity among the group. Rigorous comparative studies of these different agents in patients with Nephrotic Syndrome have not been conducted. There are even less data about non‐antihypertensive agents like Cyclosporin A (CsA), dipyridamole and indomethacin. Dietary manipulations to restrict protein and sodium intake and reducing serum lipid levels with diet and drug intervention may have additional renal benefits in selected patients.
Published Version
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