Initial episode of Nephrotic syndrome:

Investigations :

• Urine examination for proteinuria-
  
  3+ to 4+ urinary proteins
  or
  urinary protein (mg)/urinary creatinine (mg) ratio in a spot sample >2
  or
  24 hours urinary protein >40 mg/m2/hr or 50 mg/kg.
 
• Serum albumin <2.5 g/dl.
 
• Serum cholesterol >200 mg/dl.
 
• To screen for tuberculosis - X-ray chest, Mantoux Test
 
• To screen for urinary tract infection - Urine culture and colony count.
 
• HbsAg test.
  [Steroid therapy is started after the infection is cleared (for TB, after 3-4 weeks of 2 anti TB drugs)].
  
 
• Low serum C3 levels, raised BUN/S. Creatinine, persistent microscopic hematuria/ macrohematuria and persistent hypertension are uncommon in minimal change NS and kidney biopsy is needed if 2 or more of these are detected, prior to starting steroid therapy.
  

Treatment:

Steroid therapy is the mainstay of the treatment of NS in children. Standard regime is as follows:

Oral prednisolone 2 mg/kg/day or 60 mg/m2 /day -bid/tid for 4-6 weeks, followed by 1.5 mg/kg or 40 mg/m2 on alternate days as a single dose for 4-6 weeks.

Remission is defined as urinary albumin absent/trace on 3-4 consecutive days. Good response is achieved in 93-95% of minimal change NS in initial episode, whilst non-minimal changes respond poorly. Those who fail to respond to standard 4 weeks' daily steroid therapy are steroid - resistant cases and they should undergo kidney biopsy to classify them under appropriate histological diagnosis which helps in future planning of therapy.