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Suggest Treatment For Nephrotic Syndrome

Posted on Thu, 8 Jan 2015

Question: My son is 2 years and 3 months old. He is suffering from Nephrotic Syndrome Minimal Change. This was diagonsed last week. He was having swelling all over his body and so we rushed to doctors. Now doctor has suggested Omnacortil 30 mg to start with. He is responding to steroid. I want to know whether this disease is permanently treatable? what treatment should be given to him?

Answered by Dr. Aditya Bhabhe (7 hours later)

Brief Answer:
Treatable with steroids but risk of relapse is present.

Detailed Answer:
Hello
Thank you for sending in your query.

Nephrotic syndrome is a disease in which proteins are lost in the urine which in turn causes swelling on the body. It is a common disease in children. One of the most common causes of nephrotic syndrome in children is Minimal change disease.

The appropriate initial treatment of this is steroids. Your doctor has rightly started him on Omnacortil which is a steroid. It is a good sign that your son has responded to the therapy.

We usually start decreasing the dose of steroids after a month.

However this disease is known to relapse in almost 40-50% of the children and there is no proven treatment to permanently prevent a relapse. Fortunately, most of the relapses are easily treatable with steroids.

The good thing about the disease is that in majority of the children, the frequency of relapses starts decreasing as the child grows.

I hope this was helpful.

I would be happy to answer any other questions which you may have.

Regards
Dr Bhabhe

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Aditya Bhabhe (14 hours later)

Hello Doctor,
Thanks for answering my question. I also wanted to ask that should we consult a child nephrologist?

And what precaution should we take in future so that after we stop giving him medicine, the relapse does not occur?

Thanks

Answered by Dr. Aditya Bhabhe (4 hours later)

Brief Answer:
Monitor urine protein at home

Detailed Answer:
Hello again,

If the services of a paediatric nephrologists are easily available you can consult him/her. Otherwise it is quite reasonable to continue treatment with a qualified nephrologist or a paediatrician.

The commonest trigger for a relapse is viral infections. So whenever your son gets fever, cough, cold etc. you should monitor his urine for proteins. This can be done at home by using urine dipsticks. Your doctor can teach you how to use the dipsticks. You should see the doctor immediately if urine starts to show proteins.

In some patients who relapse frequently we have medications to prevent relapses but since this is the first episode, the appropriate treatment at this point is steroids.

I hope this was helpful.

Regards

Dr Bhabhe

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Aditya Bhabhe (1 hour later)

Hello Doctor,
My kid was very healthy. We had never visited to any doctor earlier except while vaccinating him and suddenly it was an outburst for us. We were surprised seeing him swollen and doctor diagnosed him as Nephrotic Syndrome. Still I have a confusion about this, whether he is really suffering from NS. So can you suggest what all tests should have been done in order to confirm about this disease? Also, if you could help us analyzing what was the reason due to which he caught this disease?

Currently, following tests were done for him:
CBC,
RBC,
Thyroide,
Urine,
Stool,
Urine Culture,
Creatinine,
Cholestrol

Thanks

Answered by Dr. Aditya Bhabhe (15 hours later)

Brief Answer:
Looks like nephrotic syndrome

Detailed Answer:
Hello

The lab results are quite suggestive of Nephrotic syndrome. Some additional tests which we perform include Ultrasound of the kidneys and UPCR (Urine protein to creatinine ratio).

If the child gets frequent relapses or does not respond to steroids we may perform additional tests.

The presentation too is quite typical of Minimal change disease. It usually occurs in otherwise healthy children as a rapid onset of swelling and a dramatic response to steroid treatment.

It is difficult to explain, to a non-medical person, the exact reason as to why this disease occurs in some children. It is believed to be auto-immune disease (body acting against itself), sometimes triggered by a viral infection.

Regards
Dr Bhabhe

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Aditya Bhabhe (3 days later)

Hello Doctor,
Thanks for your reply.
I am seeing some changes in my son like..
My kid is eating too much, he has become bony and he has lost his muscels. His eyes look different to me. Are these side effects of his medicine.If yes, then will this can be overcome after we stop giving him this medicine?

Also, I would like to know whether this treatment will really treat his problem of NS or this is just an alternative and the body will recover from this disease automatically?

Thanks

Answered by Dr. Aditya Bhabhe (26 hours later)

Brief Answer:
Not a permanent cure.

Detailed Answer:
Hello

Use of steroids can cause a child to eat more as well as puffiness of face. Your son may also be looking different because of rapid decrease in swelling. Once the dose of steroids is reduced, these side effects will reduce.

This treatment is not a permanent cure of nephrotic syndrome. Like I said earlier there remains a risk of relapse of the disease.

With growing age the risk of relapses decreases.

Regards
Dr Bhabhe

Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju