Nephrotic syndrome
1. Big picture
Nephrotic syndrome in children is a clinical syndrome caused by massive urinary protein loss due to increased permeability of the glomerular filtration barrier.
The classic pediatric exam picture is:
Preschool boy + periorbital edema + massive proteinuria + hypoalbuminemia + hyperlipidemia + normal blood pressure + normal renal function
The most common cause in children is minimal change nephrotic syndrome, which usually responds well to corticosteroids and usually has an excellent prognosis.
The danger is not only edema. Children with nephrotic syndrome are at risk of:
- Severe infections, especially spontaneous bacterial peritonitis
- Thrombosis
- Hypovolemia or acute kidney injury
- Pulmonary edema if fluids/albumin are misused
- Relapses and steroid toxicity
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