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Have I had a nephrotic syndrome relapse?

Q: I had my first attack of Nephrotic Syndrome 15 years back at the age of 16 years. At that time I was admitted into a hospital where I took Prednisolone 60 mg/day along with Penicillin (LA12) biweekly. The said dose gradually reduced day after day. At that time albumin present in my urine was + + +. Some parts of my body especially around eyes, legs and belly were swollen. I also had high fever and headache. After a prolonged treatment I recovered completely. But after a span of 24 years I again had an attack of Nephrotic Syndrome this month because albumin was + and some parts of my body were swollen again, I noticed it after a cough and cold attack. The doctor said it is a relapse after a long gap. My question is that is it not a curable disease? Is there any relationship with cough and cold? I am totally puzzled and want your advice for necessary restriction and precautions? At present I am taking Prednisolone.

A:You probably had Minimal Change Disease at age 16, which constitutes most common cause of nephrotic syndrome in that age. Relapse after 24 years is truly rare but can not be completely ruled out. However, relationship with viral infections (as you have described) is well known. However, it is also possible that you have another illness related to viral illness which may have similar presentation but different course and treatment. You have not described other findings of urinalysis and certain lab values (serum albumin, cholesterol, blood sugar etc), it is difficult to comment whether it is the relapse of same illness or a different disease. It must be stated however that viral illness or infections in general can lead to transient appearance of albumin in urine which is self limited and goes away with time.

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