How to Overcome Side Effects of Steroids for Nephrotic Syndrome Patients

How to Overcome Side Effects of Steroids for Nephrotic Syndrome PatientsHow to overcome side effects of steroids for Nephrotic Syndrome patients?

Glucocorticoid is the first-line drug for Nephrotic Syndrome patients to treat massive proteinuria.

Short-acting steroids such as cortisone and hydrocortisone are ineffective, so they are less used; long-acting steroids such as dexamethasone and betamethasone have great side effects, so they are also rarely used. In the treatment of Nephrotic Syndrome, the most commonly used is the intermediate-acting steroids, such as prednisone, methylprednisolone and so on. Their curative effects and side effects are relatively balanced.

After the use of steroids, patients will have more adverse reactions, and there are corresponding preventive measures and treatment measures for these adverse reactions.

1. Moon face, buffalo back, centripetal obesity, steroid-induced diabetes mellitus, hirsutism, acne, etc.

Glucocorticoids can cause metabolic disorders of three major nutrients: sugar, lipid and protein in human body, resulting in such symptoms. Generally, no special treatment is needed. When the drugs are stopped, these symptoms will disappear.

Prevention: Low sugar and high protein diet, and potassium chloride can be added if necessary. After taking steroids, appetite will increase, so you should pay attention to controlling appetite and losing weight.

2. Swelling, low blood potassium and high blood pressure.

Steroids can disturb the metabolism of water and salt, causing water and sodium retention.

Prevention: low salt and high potassium diet. To add spironolactone and other potassium-preserving diuretics when necessary.

3. Induced infection

Glucocorticoids can inhibit immune function and induce or aggravate infections, such as colds, gastroenteritis, urinary tract infections and respiratory tract infections.

Prevention: To detect potential infections such as tuberculosis and hepatitis, inject influenza vaccine and pneumococcal vaccine every year, and use immunomodulator to improve immune function when necessary.

4. Gastric ulcer and perforation

Steroids can stimulate gastric acid secretion, reduce gastric mucosal resistance, and may induce gastric ulcer and gastric perforation.

Prevention: To use proton pump inhibitors (prazole drugs) to prevent gastric ulcer under the following conditions.

(1) Non-steroid anti-inflammatory drugs such as aspirin, ibuprofen, paracetamol, indomethacin, diclofenac, meloxicam and celecoxib are also used.

(2) History of gastrointestinal ulcer and upper gastrointestinal bleeding within 1 year

(3) Antiplatelet and anticoagulant drugs are used at the same time.

(4) Coagulation dysfunction

(5) Positive occult blood in stool

5. Osteoporosis

Steroids can suppress the activity of osteoblasts, increase the excretion of calcium and phosphorus, inhibit the absorption of calcium in the intestine, and increase the sensitivity of osteocytes to parathyroid hormone, leading to osteoporosis.

Prevention: Active vitamin D supplementation, and calcium supplementation.

6. Femoral head necrosis

Long-term use of high-dose steroids can increase blood lipids and blood viscosity so as to block blood vessels, which may lead to blood supply disorders of the femoral head, resulting in necrosis of the femoral head. The incidence is low, but the consequences are serious. Hip replacement or long-term wheelchair may be necessary.

Prevention: The incidence of femoral head necrosis is very low within 3 months of steroid use, and it mostly occurs between 5 and 8 months. After 5 months of steroid use, magnetic resonance imaging should be performed to screen for early femoral head necrosis.

7. Neuropsychiatric disorder

Steroids can cause various forms of behavioral abnormalities, including euphoria, hypersensitivity, excitement, insomnia, emotional changes or even obvious psychiatric symptoms, and can also induce seizures. Some patients also have suicidal tendencies.

Prevention: Close observation after medication. If there are psychiatric symptoms, antipsychotic drugs can be used, and symptoms can be improved by themselves after steroid reduction.

8. Cataract/glaucoma

The dosage of steroid is more than 10 mg/day, or the use of steroid for more than one year can lead to hydrocele of lens fibers and protein agglutination so as to cause cataract. It can also elevate intraocular pressure, inducing glaucoma.

Prevention: Regular ophthalmologic visits are helpful for early detection of steroid-induced glaucoma and cataract, and early detection has a good therapeutic effect.

These eight kinds of side effects of steroids do not necessarily all occur. Usually, after a patient uses intermediate-acting steroids, only a small number of side effects occur. However, kidney patients should also pay close attention to the serious side effects. When they occurs, contact the doctor immediately.


***Please seek professional medical advise for the diagnosis or treatment of any ailment, disease or medical condition. This article is not intended to be a substitute for the advice of a licensed medical professional.***

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