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Nephrotic syndrome in children

Wednesday, 18 April 2001
Answered by: Dr. Rekha Agrawal
Associate Prof. Paediatrics
Director Paediatric Nephrology
Loyola University Medical Center
Illinois

Q. My son of 3.5 years was having swollen limbs and especially penis & scrotum. It was detected as Nephrotic Syndrome, which was confirmed after tests. He was hospitalised for 15 days. Before this he only had mild cough & cold for 10-15 days. Right now he is taking Prednisolone 10mgx2 and Distaclor 5mlx3. My question is, what precaution we should take to avoid repeated attack of this? What is your advise about food etc? Any specific suggestion? How harmful is this disease on the long-term health of the kidney?

A.  Nephrotic syndrome in a young child like your son generally responds well to prednisone( 80-90% )and the urine protein goes away. In about 20% it may not come back, but in the rest, protein starts reappearing in urine, often triggered by an infection eg. a cold. There is no way of preventing this, either by diet or any other measure. We advise these children to lead normal lives. We teach all the parents to learn to test the urine at home for protein, using dipsticks, initially about 3-4 times a week, daily if the child has an infection. If protein comes back and stays for more than 3-4 days, we often treat with prednisone, usually for just a few days, since the disease relapse is picked up early, before the child gets swollen. Fruits are good for your child, I do not know why you are avoiding them. We advise salt restriction. In most children there is no underlying cause for the Nephrotic syndrome. For unknown reasons, the charges on the kidney change, making the kidney pores bigger so that protein leaks out in the urine. Prednisone closes the pores stopping the leakage of protein. If your child needs prednisone constantly or gets protein in the urine more than 3 times a year, you might talk to your physician about other medications. Also if your child has never had chickenpox or received the chickenpox vaccine, then each time he comes in contact with a child with chickenpox, you should call your pediatrician for protective treatment. I would advise a blood test for chicken pox antibodies to see if your child has natural immunity against chicken pox.

A.  Nephrotic syndrome in a young child like your son generally responds well to prednisone( 80-90% )and the urine protein goes away. In about 20% it may not come back, but in the rest, protein starts reappearing in urine, often triggered by an infection eg. a cold. There is no way of preventing this, either by diet or any other measure. We advise these children to lead normal lives. We teach all the parents to learn to test the urine at home for protein, using dipsticks, initially about 3-4 times a week, daily if the child has an infection. If protein comes back and stays for more than 3-4 days, we often treat with prednisone, usually for just a few days, since the disease relapse is picked up early, before the child gets swollen. Fruits are good for your child, I do not know why you are avoiding them. We advise salt restriction. In most children there is no underlying cause for the Nephrotic syndrome. For unknown reasons, the charges on the kidney change, making the kidney pores bigger so that protein leaks out in the urine. Prednisone closes the pores stopping the leakage of protein. If your child needs prednisone constantly or gets protein in the urine more than 3 times a year, you might talk to your physician about other medications. Also if your child has never had chickenpox or received the chickenpox vaccine, then each time he comes in contact with a child with chickenpox, you should call your pediatrician for protective treatment. I would advise a blood test for chicken pox antibodies to see if your child has natural immunity against chicken pox.

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