Side Effects of Corticosteroid Therapy in Nephrotic Syndrome: What Patients Should Know

Understanding the Role of Steroids in Treating Nephrotic Syndrome

Nephrotic syndrome is a serious kidney disorder characterized by excessive protein in the urine, low blood protein levels, high cholesterol, and significant swelling. One of the most common treatments prescribed by physicians is corticosteroid therapy, particularly glucocorticoids like prednisone. While these medications can effectively reduce inflammation and suppress the immune system to control proteinuria, they also come with a range of potential side effects that patients need to be aware of.

Common Side Effects Associated with Long-Term Steroid Use

Corticosteroids are powerful drugs, but their benefits often come at a cost. When used for extended periods or at high doses, they can lead to several adverse effects across multiple body systems. It's essential for patients and caregivers to understand these risks to make informed decisions and monitor symptoms closely during treatment.

Elevated Blood Sugar Levels

One of the most frequently observed side effects is hyperglycemia, or increased blood glucose. Steroids interfere with insulin function, reducing glucose uptake by cells and promoting glucose production in the liver. This can lead to steroid-induced diabetes, especially in individuals with a family history of diabetes or those who are overweight. Regular blood sugar monitoring is crucial during therapy, and dietary adjustments or additional medications may be required to manage this condition.

Physical and Cosmetic Changes

Prolonged steroid use often results in noticeable changes in appearance. These include facial rounding (commonly known as "moon face"), accumulation of fat around the upper back ("buffalo hump"), and central obesity. Such changes can be particularly distressing for younger patients and women, affecting self-esteem and emotional well-being. While many of these effects are reversible after tapering off the medication, they can significantly impact quality of life during treatment.

Gastrointestinal Complications

Steroids can irritate the lining of the stomach and intestines, increasing the risk of gastritis, peptic ulcers, gastrointestinal bleeding, and even perforation in severe cases. To mitigate these risks, doctors often prescribe proton pump inhibitors or other gastroprotective agents alongside steroid therapy. Patients should report any persistent abdominal pain, nausea, or black stools immediately, as these could indicate internal bleeding.

Bone Health Deterioration

Long-term corticosteroid use is a leading cause of drug-induced osteoporosis. These medications reduce bone formation, increase bone resorption, and impair calcium absorption, all of which weaken the skeletal structure. As a result, patients face a higher risk of fractures, even from minor falls. In more severe cases, avascular necrosis—particularly of the femoral head—can occur, causing debilitating joint pain and potentially requiring surgical intervention. Calcium supplements, vitamin D, and weight-bearing exercises are typically recommended to support bone health.

Neuropsychiatric Symptoms

Mood and cognitive disturbances are not uncommon during steroid treatment. Patients may experience heightened anxiety, restlessness, insomnia, or difficulty concentrating. Some may develop more severe psychiatric reactions such as depression, hallucinations, or even psychosis, especially at high doses. These effects usually improve once the dosage is reduced, but psychological support or medication may be necessary in certain cases.

Impact on Liver Function and Latent Infections

Steroids can exacerbate pre-existing liver conditions or unmask hidden infections due to their immunosuppressive nature. Individuals with underlying hepatitis B, for example, may experience viral reactivation, leading to acute liver damage. Similarly, dormant tuberculosis can become active again if not properly screened and treated before starting steroids. Comprehensive screening for infectious diseases and regular liver function tests are therefore critical components of safe steroid management.

Striking a Balance: Weighing Benefits Against Risks

While corticosteroids remain a cornerstone in managing nephrotic syndrome, especially in minimal change disease and other responsive forms, their use must be carefully monitored. Physicians aim to prescribe the lowest effective dose for the shortest possible duration to minimize complications. Tapering schedules, lifestyle modifications, and adjunct therapies play key roles in reducing dependency and protecting overall health.

In conclusion, awareness and proactive management of steroid-related side effects are vital for achieving optimal outcomes. With proper medical supervision, patient education, and regular follow-ups, it's possible to harness the therapeutic power of corticosteroids while minimizing their drawbacks.