Therapy of Idiopathic Nephrotic Syndrome in Adults

The therapy of idiopathic nephrotic syndrome remains controversial. Depending on the underlying glomerular lesion, a conservative or aggressive approach may be indicated. The choice is also dictated by likelihood of progressive renal failure, the complications of the untreated nephrotic state, and the adverse effects of therapy. Three lesions responsible for a large percentage of idiopathic nephrotic syndrome are discussed, namely minimal change disease, membranous glomerulonephritis and focal and segmental glomerulosclerosis. The relative indications for a conservative or aggressive approach are reviewed for each of these lesions and a suggested approach to management is presented.