Do You Have to Take Steroids for Nephrotic Syndrome?
Nephrotic syndrome is a complex kidney disorder characterized by excessive protein in the urine, low blood protein levels, high cholesterol, and swelling—particularly around the eyes, feet, and hands. While treatment strategies vary depending on the underlying cause and severity, one of the most common and effective approaches involves the use of immunosuppressive medications, especially corticosteroids like prednisone.
Why Immunosuppressants Are Often Recommended
The root cause of many cases of nephrotic syndrome lies in immune system dysfunction. When the body's immune response becomes unbalanced, it can mistakenly attack the kidneys' filtering units (glomeruli), leading to damage and protein leakage. Corticosteroids help suppress this abnormal immune activity, reducing inflammation and restoring normal kidney function over time. For conditions like minimal change disease or focal segmental glomerulosclerosis, steroid therapy is often the first-line treatment due to its proven efficacy.
When Might Steroids Be Delayed?
However, not every patient needs to start steroids immediately. In certain cases—particularly early-stage membranous nephropathy (Stage I or II)—doctors may opt for a "watch-and-wait" approach. Research shows that approximately one-third of patients with early membranous nephropathy experience spontaneous remission within 3 to 6 months, and almost all such cases occur within 12 months.
Conservative Management During Observation Periods
During this observation window, medical professionals typically recommend supportive therapies to manage symptoms and protect kidney health. These include:
- ACE inhibitors (e.g., lisinopril) or ARBs (e.g., losartan) to reduce proteinuria and control blood pressure
- Lifestyle modifications such as adequate rest, avoiding overexertion, quitting smoking, and abstaining from alcohol
- Adjunctive herbal-based treatments like Bailing capsules, Shenyankangfu tablets, or Jinshuibao tablets—often used in integrative medicine protocols
These measures aim to create an optimal internal environment that supports natural healing while minimizing further kidney stress.
When to Start Immunosuppressive Therapy
Even in early membranous nephropathy, aggressive treatment with immunosuppressants becomes necessary if clinical signs are severe. For example, if a patient presents with more than 8 grams of protein in their urine per 24 hours, the likelihood of spontaneous recovery drops significantly. In these instances, waiting could lead to irreversible kidney damage. Early intervention with corticosteroids combined with other immunosuppressants (such as cyclophosphamide or rituximab) can dramatically improve outcomes and bring about faster symptom relief.
Personalized Treatment Plans Are Key
Ultimately, managing nephrotic syndrome isn't a one-size-fits-all process. A tailored approach based on biopsy results, disease stage, symptom severity, and overall health status ensures the best possible prognosis. Regular monitoring through blood tests, urine analysis, and imaging helps doctors decide whether to continue conservative care or escalate to steroid therapy.
With proper medical guidance, lifestyle adjustments, and timely interventions, many patients achieve remission and maintain good long-term kidney function—even without immediate steroid use in select cases.