The accuracy of using the initial response to prednisone to identify children with minimal glomerular changes has been assessed in a prospective study of children between 12 weeks and 16 years of age with the primary nephrotic syndrome. The results indicate that, as generally held, the likelihood is quite high, although not 100%, that a child with the primary nephrotic syndrome who responds during eight weeks of initial intensive steroid treatment has MCNS. Prognosis in these patients can be considered to be very favorable and renal biopsy need not be done unless indicated by the subsequent clinical course. However, the prediction that a patient who fails to respond has a glomerular lesion other than MCNS would be incorrect in about one-fourth of all patients with the primary nephrotic syndrome, and in as many as one-half of patients less than or equal to 6 years of age. For these patients, predictions concerning prognosis should be withheld until a renal biopsy provides a histopathologic diagnosis.
Medications that lower blood pressure can also significantly slow the progression of kidney disease causing nephrotic syndrome. Two types of blood pressure lowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease by reducing the pressure inside the glomeruli and thereby reducing proteinuria. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretic—a medication that aids the kidneys in removing fluid from the blood—can also be useful in helping to reduce blood pressure as well as edema. Beta blockers, calcium channel blockers, and other blood pressure medications may also be needed.