Nephrotic syndrome is an immune-based kidney disease characterized by loss of protein
in the urine, resulting in low protein levels in the blood and fluid
Nephrotic syndrome may be idiopathic where the
cause is not known, or secondary due to other conditions like systemic lupus
‘Azithromycin prevented relapses of nephrotic syndrome in a child, thus suggesting a possible new role for the drug.’
syndrome includes minimal-change nephrotic syndrome (MCNS) and focal segmental
glomerulosclerosis (FSGS). The fluid accumulation may be mild or severe
resulting in swollen legs and a bulging abdomen. The diagnosis is based on
urine and blood tests, and imaging tests like kidney ultrasound. Nephrotic
syndrome can cause complications like infections and thrombosis (formation of
blood clots within blood vessels).
like prednisolone are the mainstay of treatment for nephrotic syndrome
Unfortunately, several children show relapses following treatment, and require
repeat courses. The long term use of corticosteroids is associated with several
adverse effects which include bone thinning, gastritis, weight gain, repeated
infections, skin thinning and muscle weakness. Some patients are put on
immunosuppressive treatment, which is again associated with side effects. A
safer alternative would therefore be preferred, especially in children who
require long-term treatment.
have reported the successful use of azithromycin in a child with idiopathic
nephrotic syndrome in preventing relapses
. Azithromycin is an
antibiotic which belongs to the macrolide group, the same group that also
Its once a day administration due to its prolonged residence in tissues, its
stability in acid, lesser drug interactions and effect against a larger
spectrum of bacteria make it a preferred alternative to erythromycin.
The 2-year-old boy with
idiopathic nephrotic syndrome was first treated with oral prednisolone, with
which he recovered. One month after stopping treatment, the child suffered from
a relapse that did not respond to dietary restriction but responded to oral
prednisolone again. However, reducing the dose of prednisolone again resulted
in a relapse.
the child was given azithromycin daily for 3 days, there was a remarkable
improvement in the disappearance of the proteins in the urine
. Though they
reappeared again, on repeating the treatment with azithromycin, the effect was
maintained and the child was free from relapses till the study was sent for
Though it is not
definitely known how azithromycin brought about the effect, the authors of the
report put forth several suggestions. These are:
could be acting as an immunomodulator to prevent relapses.
- Azithromycin may
prevent bacterial infections
which are a frequent cause of relapses of nephrotic syndrome.
- Azithromycin may
have some effect on the kidney cells to reduce the excretion of protein in
Another report published
earlier also suggested that azithromycin suppressed disease activity in
the effect of azithromycin in preventing relapses of nephrotic syndrome cannot
be confirmed only based on the case report, it is worth further investigation
Azithromycin has already been in the market for a considerable amount of time.
Its adverse effect profile is much better when compared to steroids or
immunosuppressive drugs, and would be a good alternative. Its safety on
long-term use, however, will also have to be established before it is used for
- Hara H, Hirano D. Azithromycin suppressed relapses of idiopathic nephrotic syndrome in a child. Clinical Kidney Journal, sfx099, - (https:doi.org/10.1093/ckj/sfx099)