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Does my child with nephrotic syndrome need steroids?

Q: My son aged 3 years is suffering from nephrotic syndrome. After giving predone forte, the protein in urine has become NIL. But whenever he gets cold or any infection the protein re-appears in urine. It starts with + and gradually it becomes (over period of 3 months) +++. Again predone has to be given. Frequent relapse is there. I am afraid to give steroids as it has a number of side effects. I am worried about his health. Is any other treatment there?

A:Your son has what is known as Minimal Change Disease. Childhood onset minimal change disease carries an overall good prognosis and responds very well to prednisone most of the times. It is not unusual to witness temporary increases in proteinuria following episodes of illnesses like viral infection which may require escalating doses of steroids. It does not appear that he is steroid dependent wherein discounting steroids results in reemergence of proteinuria which is a good indicator. Aside from using a group of medicines called ACE inhibitors, which help contain proteinuria and preventing infections, there is little that could be done at this time since alternative regimens are clearly more toxic and carry higher incidence of side-effects.

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