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
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