Q: My 2-year-old daughter has been diagnosed with nephrotic syndrome and is being given Predone Forte syrup. Doctors say that the medicine has to be continued for 6 weeks 5ml twice a day. After this for the next 6 weeks, it will be the same dosage on alternate days. Will the intake of steroids affect her growth or immunity in any way? Is it good to take this amount of steroid at this young age? Doctors also say that this might relapse in future. What are the causes for this disease and how can we prevent it?

A:Your daughter probably has “Minimal Change Disease” (MCD), a kidney disease characterised by massive leakage of protein in the urine. It results in the swelling of the face and the extremities including the feet and hands and occasionally causes the blood pressure to rise. It is the commonest cause of nephrotic syndrome (syndrome defined by the presence of huge amount of urine protein and swelling of the body parts) in children. The cause is most often idiopathic (unknown) though occasionally can occur secondary to viral or bacterial infections, common medications like pain medications (Brufen) or antibiotics, following an immunisation or certain tumours. The inciting agent triggers an immune response, which damages the kidney’s filtering cells, ultimately leading to the urinary protein leakage. Corticosteroids are the standard line of treatment in children with MCD. They are given for particular duration - usually 6-8 weeks - before the response to the treatment can be gauged from a decrease in the urinary protein leakage. In a majority of cases in children, steroids lead to a complete remission (improvement) of proteinuria (protein in urine). The side effects of the steroids are minimal without any effect on the growth of the child as long as the medication is taken as prescribed and under the close supervision of the child’s nephrologist.