Nephrotic Syndrome: First Episode Management
Nephrotic syndrome is defined by massive proteinuria (>40 mg/m²/hr or spot morning protein/creatinine ratio >2), hypoalbuminemia (<2.5 g/dL), edema, and hyperlipidemia.
1. Diagnostic Criteria
- Proteinuria: Massive (≥3+ on dipstick).
- Hypoalbuminemia: Serum albumin < 2.5 g/dL.
- Edema: Often starts as periorbital edema, progressing to generalized edema (anasarca).
2. Management of 1st Episode (ISKDC Protocol)
| Phase | Corticosteroid Regimen (Prednisolone) |
|---|---|
| Daily Phase | 60 mg/m²/day (or 2 mg/kg/day) for 6 weeks. |
| Alternate Day | 40 mg/m² (or 1.5 mg/kg) on alternate days for 6 weeks. |
3. High-Yield Clinical Pearls
- Biopsy Criteria: Renal biopsy is not required for the first episode in a typical child (aged 1–10 years) with no hematuria, normal blood pressure, and normal renal function.
- Infection Risk: Children are immunocompromised (loss of IgG, complement factors in urine); they are at high risk for spontaneous bacterial peritonitis (SBP).
- Edema Management: Salt restriction and judicious use of diuretics (e.g., furosemide) only if edema is symptomatic/severe, not for weight loss alone.
NEET PG Hint: Remember: Minimal Change Disease (MCD) is the most common cause of idiopathic nephrotic syndrome in children. It is highly steroid-sensitive. For more high-yield pediatric nephrology and free medical questions, visit mymedschool.org.