Nephrotic syndrome in children

Question 1

Triad of nephrotic syndrome and other features

Answer 1

Low serum albumin
High urine protein (>3+ dipstick)
Oedema

Deranged lipids e.g. high cholesterol, TG, LDLs
High BP
Hypercoagulability

Question 2

Presentation of nephrotic syndrome

Answer 2

Frothy urine
Oedema
Pallor

Question 3

Causes of nephrotic syndrome in children

Answer 3

Most commonly it is minimal change disease (>90% in under 10) - nephrotic syndrome without any clear underlying condition

Secondary to intrinsic kidney disease e.g. FSGS

Secondary to systemic illness e.g. HSP, DM

Question 4

Investigations

Answer 4

FBC
LFTs - (low serum albumin)
U&Es
Lipid profile
Clotting

BP

Urine dip
Urinalysis - (will show small molecular weight proteins and hyaline casts in minimal change disease)

Question 5

Management of nephrotic syndrome

Answer 5

High dose steroids e.g. prednisolone
Low salt diet
Diuretics - to treat oedema

Steroids for 4 weeks then gradually weaned

Question 6

Complications of nephrotic syndrome

Answer 6

Hypovolaemia - causing oedema and hypotension

Thrombosis - proteins that normally prevent blood clotting are lost in the kidneys, and because the liver responds to the low albumin by producing pro-thrombotic proteins

Acute or chronic renal failure

Relapse of the condition