Diagnosis & Management of First Episode of nephrotic syndrome

Nephrotic syndrome is diagnosed in a child with 

  • Edema: usually starts as periorbital puffiness with variable degree of generalized body swelling.
  • Heavy proteinuria: defined as urine dipstick protein 3+/4+ or spot urine protein creatinine ratio Up/Ucr > 2 mg/mg 
  • Hypoalbuminemia: serum albumin <2.5 gm/L
  • Hypercholesterolemia: serum cholesterol >200 mg/dl

All children with first episode of nephrotic syndrome should undergo detailed clinical assessment for presence of complications like massive edema, hypovolemia, presence of any serious infections and features suggestive of systemic illness. It is preferable to treat any complications before starting steroid treatment.

 Management of First episode

The standard treatment of nephrotic syndrome is prednisolone. It should be started at 2 mg/kg/day in single morning or two divided doses for 6 weeks followed by 1.5 mg/kg/day as single morning dose on alternate days for 6 weeks. After 12 weeks steroids are stopped without tapering. 

Management of edema depends upon the severity.

Mild edema: Salt restriction

Moderate edema : Salt restriction, frusemide at 1-2mg/kg/day.

Severe/Refractory edema  : Salt restriction, frusemide, spironolactone, albumin infusion

Next post : Management of Relapses

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.