Nephrotic Syndrome Management
Nephrotic Syndrome Management
Contents Page
Working group and workshop participants 1
3. Management 4
3.4.2. Relapse 7
3.5. Cyclophosphamide 8
5. Definitions 11
6. References 12
CONSENSUS STATEMENT:
MANAGEMENT OF IDIOPATHIC NEPHROTIC SYNDROME IN CHILDHOOD
WORKSHOP PARTICIPANTS
CONSENSUS STATEMENT:
MANAGEMENT OF IDIOPATHIC NEPHROTIC SYNDROME IN CHILDHOOD
Although said to be uncommon in the West at about 3 new cases per 100,000
child population, data suggests that Asians have a higher incidence at about 16
new cases per 100,000 child population . 1 Although there is no available local
data, it is felt that the incidence in Malaysia is also higher than in the West.
1. Urine protein excretion greater than 40 mg/m 2/hour on a timed urine collection
or an early morning urine protein creatinine index of >200 mg/mmol;
2. Hypoalbuminaemia of <25 g/l,
3. Oedema.
4. Hypercholesterolaemia is not needed in definition.
It is important to ensure that there is no known primary renal disorder that has
led to the nephrotic syndrome, in particular that associated with post infectious
glomerulonephritis as the treatment for the nephrotic syndrome then depends on
the treatment of the primary renal disease.
In general, the above list of investigations may suffice for children below 8 years
of age presenting with nephrotic syndrome without any other clinical features.
The International Study of Kidney Disease in Children (ISKDC) had found that at
the initial presentation of children with minimal change nephrotic syndrome -
1 20.7% of children had systolic blood pressure above 98th percentile for age;
2 22.7% had microscopic haematuria
3 32.5% had transiently raised plasma creatinine concentration
3. MANAGEMENT
This is not required and usually not practical unless the child has gross
oedema.
B. Diet
11. Antibiotics.
12. Hypovolaemia.
14. Diuretics.
15. Hypercholesterolaemia