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Suggest treatment for severe nephrotic syndrome

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Posted on Fri, 4 Dec 2015
Question: G’day Dr,
Last month My son (Age: 2 year 4 months) had severe edema in his scrotum, puffy eye lids, belly and legs. After diagnosis it was found to be nephrotic syndrome. Doctor prescribed Steroid Prednisolone 25 mg/day for 2 weeks. Edema started reducing and his weight came down from 12.4Kg to 10.6 Kg. No significant side effects because of the steroid. When we checked the urine Protein Albumin, it was still showing 4 + after two weeks. Doctor prescribed to continue the steroid for another 2 weeks and now all his edema has gone fully with very mild puffy eye lids still.
When we checked Urine sample 4 days back it was showing NIL Protein Albumin and again we checked the Urine sample today nearly after 4 weeks of steroid treatment, it was again showing 3+. Last week he had cold & cough and the doctor prescribed medication for his mucus & cough( Azithral-s 5ml/200 mg and ambrodil-s) along with prednisolone for another one week. The doctor raised suspicions that he is not responding to the steroid based on the Urine sample today and Kidney biopsy may be required after one week. He also said that this might have happened because of the Cold Infections and So that we can wait for one more week by continuing the steroid treatment to see that the Urine protein comes to NIL.

I really want to know whether my son is responding to the steroid treatment since severe edema in his body has gone, he looks very normal like before and Urine Protein was also NIL 4 days ago?
Is it essential to carry out kidney biopsy after a week if the urine protein level doesn’t comes down or can we wait for some more time continuing the steroid medication?
doctor
Answered by Dr. Archana Verma (1 hour later)
Brief Answer:
No need for renal biopsy so soon

Detailed Answer:
Hi xxxxxxx,
Welcome to the HCM

I have gone through your question and understand your concerns but don't worry. The most likely reason for nephrotic syndrome in this age group is minimal change nephrotic syndrome which has excellent long term prognosis.

The therapy needs steroids ( prednisolone) at 2 mg/kg/day for 6 weeks followed by 1.5 mg/kg/day on alternate days for next 6 weeks. Most likely your son will respond once his respiratory tract infection improve and the course is complete. There is no need for renal biopsy at present.

We advice renal biopsy only when we suspect other causes for neprotic syndrome or resistant cases.

Hopefully this will help you. I would be happy to help you in any further questions.
Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Archana Verma

Pediatrician

Practicing since :2006

Answered : 1129 Questions

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Suggest treatment for severe nephrotic syndrome

Brief Answer: No need for renal biopsy so soon Detailed Answer: Hi xxxxxxx, Welcome to the HCM I have gone through your question and understand your concerns but don't worry. The most likely reason for nephrotic syndrome in this age group is minimal change nephrotic syndrome which has excellent long term prognosis. The therapy needs steroids ( prednisolone) at 2 mg/kg/day for 6 weeks followed by 1.5 mg/kg/day on alternate days for next 6 weeks. Most likely your son will respond once his respiratory tract infection improve and the course is complete. There is no need for renal biopsy at present. We advice renal biopsy only when we suspect other causes for neprotic syndrome or resistant cases. Hopefully this will help you. I would be happy to help you in any further questions. Take care