1. Medicines for Children with Nephrotic Syndrome
Angela Lamb
Paediatric Renal Pharmacist
RHSC
Glasgow
16/10/10

2. Summary Nephrotic syndrome First line management Vaccines
Prednisolone
Prophylactic medicines
Vaccines
Second line management
Third line management
Questions?

3. Nephrotic Syndrome 80% minimal change disease
Median age of presentation is 4 years
More common in boys
Triad :
Heavy proteinuria- lose lots of protein in urine
Hypoalbuminnaemia- low protein levels in blood
Oedema - fluid retention

4. Nephrotic Syndrome Relapse: Remission:
Albustix +++protein in urine for 3 consecutive days
Remission:
Albustix –ve or trace protein in urine for 3 consecutive days

5. Prednisolone First line therapy Immunosuppressant affect 90% respond
4 weeks daily high dose
4 weeks alternate day
Reduce over 6 months

6. Prednisolone Advice Never miss a dose Do not run out
Always carry blue steroid warning card
Take in the morning

7. Prophylactic medicines
Antibiotic:
Penicillin V (Phenoxymethylpenicillin)
Twice daily
Prevent infection
Stop when in remission

8. Prophylactic medicines
Ranitidine:
Prevent upset stomach
While on high dose prednisolone
Stop when dose of prednisolone reduced to 10mg alternate days

9. Vaccinations All routine vaccines up to date
Live vaccines (3 months or 6 months)
MMR
Varicella (chicken pox)
Pneumococcal vaccine (every 5 years)
Flu vaccine (every year)

10. Second line management
Immunosuppressant:
Levamisol
Alternate day dosing
Continuous treatment
Ciclosporin
12 hourly dosing
Check blood levels
Other medicines can affect blood levels

11. Second line management
Immunosuppressant:
Tacrolimus
Every 12 hours
One hour before food
Blood levels check
Other medicines can change levels
Mycophenolate mofetil
May be given up to four times a day
Blood checked

12. Third line treatment
Monoclonal antibodies
Rituximab

13. Questions ?