Recurrence of proteinuria more than 3+/4+ by dipstick testing, for 3 consecutive days with swelling constitutes a relapse. Prednisolone is given @ 2 mg/kg/day till urine protein is negative/trace for 3 consecutive days, followed by 1.5 mg/kg/day on alternate days for 4 weeks.
Steroids are stopped without tapering.
During any relapse look for an infectious trigger. One can manage 2 to 3 relapses in a similar manner. After this refer to Pediatric nephrologist.
Must Refer to pediatric nephrologist in following scenarios
- Onset below one year of age,
- Family history of nephrotic syndrome.
- Nephrotic syndrome with hypertension
- Gross or persistent microscopic hematuria
- Impaired renal function
- Systemic features like rash, arthritis.
- Complications: severe edema, thrombosis, steroid toxicity, severe infection
- Resistant to 4 weeks of daily steroid therapy
- Frequently relapsing* or steroid dependent nephrotic syndrome**
* Frequent Relapses: Two or more relapses in six months of initial response, or more than three relapses in any twelve months.
** Steroid Dependence : Two consecutive relapses when on alternate day steroids or within 14 days of its discontinuation