Question of the Week # 348

348)  A 6 year old boy is evaluated in your office for complaints of generalized swelling of his body. His mother reports she has noticed increasing swelling of his face, abdomen and extremities over the past 3 weeks.  He does not have any significant past medical problems  There is no history of fever or sore-throat. He denies shortness of breath or cough. On examination,  he is afebrile,  Blood pressure 100/60 mm Hg,  Heart Rate 88/min, Respiratory rate is 16/minute. He appears comfortable. His face is grossly swollen. There is mild ascites. Lower extremities reveal gross edema up until the level of knees.  Urinalysis showed 3+ proteinuria, no red cell or casts. A 24 hour Urine total protein is obtained and it shows proteinuria at  7.0 gm/24 hours. Serum total protein 4.0gm% and albumin 2.0gm% .  He is advised to start sodium restricted diet. Which of the following management options is most appropriate next step for this patient?

A) Admit and start Albumin infusion

B) Corticosteroid Trial

C) Renal Biopsy

D) Obtain Anti-Streptolysin O titer

E) Furosemide

10 Responses

  1. B) Corticosteroid Trial – Minimal change disease – MCC of Nephrotic Sx in children- biopsy is not required.

  2. b

  3. b

  4. corticosteroid therapy
    (nephrotic syndrome)

  5. he has albumin <2.5 i think the ans is A

  6. B-corticosteroid trial

  7. ~A
    Un-disputed, minimal change disease.

    • it’s minimal change disease.
      ~B. corticosteroids trial is the answer.

  8. DR. Red help us!

    thx

    corticosteroid trial?

  9. Most children with nephrotic syndrome will respond to steroid treatment
    within 2-4 weeks. A remission is defined as 3 or more days of trace or
    negative on dipstick testing. Treatment is continued for a total of 12
    weeks as outlined above. If proteinuria persists beyond the first 4 weeks, refer to Renal unit for renal biopsy.
    They need steriod warning card. Vaccine Pneumovax and prophylaxis Pen V while he is having proteinuria as NS is prone to get pneumococcal infection.
    http://www.clinicalguidelines.scot.nhs.uk/Renal%20Unit%20Guidelines/Nephrotic%20Syndrome%20.pdf

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