Side Effects of Corticosteroid Therapy for Nephrotic Syndrome: What Patients Should Know
While corticosteroids are a cornerstone in the treatment of nephrotic syndrome, helping to reduce proteinuria and induce remission, they come with a range of potential side effects—especially with long-term use. Understanding these adverse effects is crucial for patients and caregivers to make informed decisions and manage treatment effectively.
Common Physical Changes: Cushingoid Appearance
One of the most visible side effects of prolonged corticosteroid therapy is the development of Cushing's syndrome-like features. This condition, often referred to as "cushinoid" appearance, includes facial rounding (commonly known as "moon face"), accumulation of fat at the back of the neck ("buffalo hump"), and central obesity. These changes occur due to altered fat metabolism and redistribution in the body and can significantly impact a patient's self-esteem and quality of life.
Metabolic Complications: Increased Risk of Diabetes
Corticosteroids can impair glucose metabolism, leading to insulin resistance and elevated blood sugar levels. Over time, this may result in steroid-induced diabetes, particularly in individuals with a family history of diabetes or other risk factors. Regular monitoring of blood glucose is essential during treatment, and some patients may require oral hypoglycemic agents or insulin therapy to maintain glycemic control.
Fluid and Electrolyte Imbalances
Another significant concern is fluid retention caused by the mineralocorticoid activity of certain steroids. This can lead to:
- Hypertension (elevated blood pressure)
- Pronounced edema, especially in the legs, abdomen, and around the eyes
- Sodium and water retention
In parallel, electrolyte disturbances such as hypokalemia (low potassium), hyponatremia or hypernatremia (abnormal sodium levels), and hypocalcemia (low calcium) may develop, requiring careful laboratory monitoring and dietary or medical intervention.
Gastrointestinal Risks: Ulcers and Bleeding
Long-term steroid use increases the risk of gastrointestinal complications, including peptic ulcers, gastric irritation, and in severe cases, perforation or gastrointestinal bleeding. The risk is further amplified when corticosteroids are combined with nonsteroidal anti-inflammatory drugs (NSAIDs). Physicians often recommend gastroprotective medications like proton pump inhibitors (PPIs) or H2 blockers to mitigate these risks.
Bone Health and Musculoskeletal Issues
Chronic corticosteroid therapy is a leading cause of drug-induced osteoporosis. It suppresses bone formation, enhances bone resorption, and reduces calcium absorption, increasing the likelihood of pathological fractures—even with minimal trauma. In rare but serious cases, high-dose steroids can lead to avascular necrosis of the femoral head (osteonecrosis), causing severe hip pain and mobility issues that may require surgical intervention.
Immune Suppression and Infection Risk
Because corticosteroids suppress the immune system, patients are more susceptible to bacterial, viral, and fungal infections. Common issues include respiratory tract infections, urinary tract infections, and reactivation of latent infections such as tuberculosis. Vaccination status should be reviewed before starting therapy, and live vaccines are generally avoided during treatment.
Endocrine and Ocular Side Effects
Prolonged use can also lead to adrenal suppression, where the body's natural cortisol production decreases due to negative feedback. This may result in adrenal insufficiency, especially during times of stress or if the medication is stopped abruptly. Additionally, increased intraocular pressure and the development of glaucoma or cataracts have been reported, necessitating regular eye exams for patients on long-term therapy.
In summary, while corticosteroids remain a vital tool in managing nephrotic syndrome, their benefits must be carefully weighed against the potential for significant side effects. Close monitoring, lifestyle modifications, and preventive strategies can help minimize risks and improve long-term outcomes for patients undergoing this treatment.