Nephrotic Syndrome in Children

Definition

Nephrotic syndrome is a clinical syndrome characterized by heavy protenuria, hypo albuminemia, oedema, and hyper cholesteronemia.

Clinical features

  • Facial oedema
  • Pedal oedema
  • Anasarca,
  • Anuria/oliguria
  • Frothy urine
  • Hypertension in10% of cases

Complications

  • Congestive cardiac failure, Pulmonary oedema
  • Spontaneous bacteria peritonitis,
  • Renal vein thrombosis
  • Acute kidney injury,
    Myocardial infarction.

Investigations

  • Urinalysis, 24hour urinary protein, serum protein (total and albumin), serum lipids, serum electrolytes, urea, creatinine, renal biopsy (when indicated)

Treatment

Objectives:

  • To reduce oedema
  • To reduce proteinuria
  • To correct lipedemia

Drug Treatment

  • Steroid at a dose of 60mg/m2/day single dose for 6-8weeks
  • Reduce to 40mg/m2 alternate days for 4 weeks and thereafter gradually taper off

Note that steroid is not indicated in ALL categories of nephrotic syndrome

  • Diuretics: slow acting like thiazides at a dose of 1-2mg/day in divided doses
  • Slow K at 1-2mg/kg/day
  • Transfusion with 25% salt poor albumin/plasma at a dose of 10ml/kg
  • Low salt diet, high protein
  • Immunization with Pneumococcal conjugate vaccine