What Is the First-Line Treatment for Nephrotic Syndrome?
At initial presentation, nephrotic syndrome requires a structured, evidence-based treatment approach. The following summarises the first-line strategy and its primary clinical target.
Treatment Approach
First-line management centres on a structured course of oral glucocorticoid therapy. The regimen involves a defined phasing schedule over a set period — the complete protocol, including sequencing and monitoring criteria, is available via the link below.
Treatment Goal
The primary target is complete remission, defined by urinary protein criteria assessed on consecutive days within the initial weeks of therapy. Achievement of this endpoint guides all subsequent management decisions.
References
We recommend that oral glucocorticoids be given for 8 weeks (4 weeks of daily glucocorticoids followed by 4 weeks of alternate-day glucocorticoids) or 12 weeks (6 weeks of daily glucocorticoids followed by 6 weeks of alternate-day glucocorticoids).
The standard dosing regimen for the initial treatment of nephrotic syndrome is daily oral prednisone/prednisolone 60 mg/m² per day or 2 mg/kg per day (maximum 60 mg/d) for 4 weeks followed by alternate-day prednisone/prednisolone 40 mg/m² or 1.5 mg/kg (maximum 40 mg) for another 4 weeks or prednisone/prednisolone 60 mg/m² per day or 2 mg/kg per day (maximum 60 mg/d) for 6 weeks followed by alternate-day prednisone/prednisolone 40 mg/m² or 1.5 mg/kg (maximum 40 mg) for another 6 weeks.
SSNS: Complete remission within 4 weeks of prednisone or prednisolone at standard dose.
Complete remission: First morning urine or 24-h uPCR ≤200 mg/g (0.2 g/g or 20 mg/mmol or negative or trace dipstick or <100 mg/m² per day) on three or more consecutive days.
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