KIDNEY FOUNDATION FOR CHILDREN

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Nephrotic syndrome is a spot diagnosis.Once seen, never forgotten. Confirming the diagnosis needs only 3 tests- Urine routine,  serum albumin and  cholesterol.

Tests not needed for making the diagnosis but which are always needed are BUN,serum creatinine and a complete blood count.It may be prudent to do a mantoux test and chest xray prior to starting steroid therapy.

Additional tests are not needed  in children presenting after one year of age unless there is gross hematuria, persistent hypertension, elevated creatinine or extrarenal symptoms and signs.

always check bun, creatinine in every child suspected to have a kidney problem

TESTS NEEDED TO ESTABLISH THE DIAGNOSIS OF NEPHROTIC SYNDROME

  • URINE ROUTINE  ALBUMIN  3+ TO 4+
  • SERUM  ALBUMIN < 2.5 G/DL
  • SERUM CHOLESTEROL > 200 MG/DL




additional tests not needed  unless the child also has

  • GROSS HEMATURIA
  • PERSISTENT HYPERTENSION
  • RAISED CREATININE
  • EXTRA RENAL SYMPTOMS AND SIGNS.

TREATMENT OF FIRST ATTACK

 

.Treatment of the first attack of nephrotic syndrome should be with prednisolone for a total period of 12 weeks. Treatment with appropriate dosage for 12 weeks has been shown to reduce the number of subsequent relapses and is now accepted as standard of care.Shorter courses should not be given for the treatment of the first attack.Response to tablet formulations is more predictable and reliable than to liquid formulations.There is no recommendation for the use of other steroid preparations such as hydrocortisone, dexamethasone, betamethasone etc ,There is inadequate evidence for the use of deflazacort for the first attack of nephrotic syndrome.

Empiric antibiotics should NOT be given just to cover steroid therapy.


Treatment of first attack of nephrotic syndrome

  • TAB PREDNISOLONE 2 MG / KG /DAY IN 2 TO 3 DIVIDED DOSES FOR 6 WEEKS

                             FOLLOWED BY

  • 1.5 MG / KG / AD AS A SINGLE MORNING DOSE FOR 6 WEEKS

STEROID SENSITIVE NEPHROTIC

SYNDROME

Response  or remission within first 4 weeks of daily steroids


remission


  • URINE ALBUMIN  -VE ON 3 CONSECUTIVE DAYS

when should you consult

a pediatric nephrologist ?


  • AGE OF  ONSET BELOW 1 YEAR
  • GROSS HEMATURIA
  • PERSISTENT HYPERTENSION
  • ELEVATED CREATININE
  • EXTRARENAL SYMPTOMS
  • SEVERE OLIGURIA
  • SEVERE INFECTION

diagnosis

DOCTOR'S DESKTOP


NEPHROTIC SYNDROME

FIRST ATTACK


HELP

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