Nephrotic Syndrome

Definition

Investigations

Treatment

• History of gradual onset generalised oedema with ascites 
• Lethargy/Poor appetite 
• Unusual in < 6mo or > 10 years (indication for biopsy) 

Definition 

• Urine Protein:Creatinine ratio of > 0,2g/mmol or Proteinuria of > 40 mg/m²/hr 
• Hypoalbuminaemia <25g/l 
• Oedema 
• Hypercholesterolaemia 

Also may have 

• Hypertension (if associated nephritic symptoms). 
• May be hypovolaemic/shocked despite appearing oedematous because intravascular fluid depletion. Increased risk of thrombosis, therefore high index of suspicion needed. 

Investigations 

• Urine: 
  • MC&S 
  • Spot urine for protein/creatinine ratio 
  • May need 24 Hr urine collection 
• Bloods: 
  • FBC/diff and smear, CEU (renal functions), Serum total protein + albumin, Cholesterol 
  • Hepatitis B Surface Antigen and antibodies, HIV Elisa (or PCR if <18mo),VDRL 
  • Streptococcus serology: ASOT, anti-DNAse B, Anti-nuclear factor in older child 
• Radiology: 
  • CXR for pleural effusions or TB 
• Mantoux: 
  • Exclude TB 

Treatment: (Discuss with Consultant) 

1. Most will respond to Prednisone 2mg/kg/day (renal team’s advice is to start all white children empirically on prednisone if no signs of nephritis or renal dysfunction. Not so for black and coloured children where the chance of minimal change is much smaller) 
2. Don’t fluid restrict - often have decreased intravascular volume 
3. Indications for albumin infusion (call renal team): 
   1. Shocked 
   2. Severe oedema 
   3. Serum Albumin under 20g/l 
   4. Eyes swollen shut/scrotum swollen tense 

Refer all Nephrotic syndromes to Nephrologist