Nephrotic Syndrome

Question 1

What is nephrotic syndrome?

Answer 1

It is a renal syndrome characterised as having the following:

• Proteinuria
• Hypoalbuninaemia
• Oedema

NephrOtic Oedema

Question 2

How do children with nephrotic syndrome often present?

Answer 2

Symptoms:
-Swollen face particularly peri-orbitally (usually the 1st symptom)

• Fatigue and malaise
• Frothy urine
• Breathlesness

Signs:

• Oedema (ascites, peripheral, facial)
• Leukonychia

Question 3

What is the most common cause of nephrotic syndrome in children?

Answer 3

Minimal change disease (by far most common)

Other causes in children include:
HSP, infections (HIV,Hep B/C, malaria) and transplant rejection.

Question 4

How should you investigate a child with nephrotic syndrome?

Answer 4

Bedside:
Urinalysis
Mid stream urine

Bloods:
FBC
LFTs
U/e's
CRP and ESR
Hep B/C and HIV screen

Question 5

How should you manage a child with nephrotic syndrome?

Answer 5

The mainstay of treatment is corticosteroid for 4-8 weeks. The majority of children will respond to this treatment and there proteinuria will resolve.

In those with atypical features or those that don’t improve will need further investigations.

Diuretics may be used to treat oedema.

Question 6

What are the atypical features of glomerulonephritis and what should be done if these are present?

Answer 6

Atypical features include:
• Older than 10 years old
• Hypertensive
• Elevated creatinine
• Macroscopic haematuria
• Failed to respond to steroids after 4-8 weeks

Child will need a renal biopsy and admitting to a specialist paediatric renal unit