Management of relapses of nephrotic syndrome

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

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