Nephrotic syndrome


  1. Edema
  2. Proteinuria (at least 3+)
  3. Hypoalbuminemia usually plus Hyperlipidemia



Minimal change disease, Focal segmental glomerulosclerosis, Membranoproliferative glomerulonephritis


Hepatitis B, HIV, Lupus, Postinfectious GN, Subacute infective endocarditis


Occur in children less than 1 year of age

Important points in history

Important points on examination

Differential diagnosis

Congestive heart failure, Kwashiokor , liver cirrhosis, protein-losing enteropathy


  1. Urine dipstick (proteinuria) and microscopy
  2. FBC, Crea, Albumin
  3. K and Na, if available
  4. HIV test
  5. Hepatitis B and C
  6. VDRL, malaria parasites
  7. Treat for Schistosomiasis
  8. Kidney ultrasound

Consider LFTs if cirrhosis possible underlying cause


  1. Infections
  2. Thromboembolism (Doppler Ultrasound)
  3. Acute kidney injury
  4. Hypovolemia
  5. Protein malnutrition
  6. Hyperlipidemia

Management - first episode

  1. Admit
  2. Salt restriction, fluid restriction if fluid overload
  3. Stat dose Praziquantel
  4. Monitor daily: blood pressure, weight (target daily weight loss) and urine dipstick until normal
  5. Encourage mobilization (bed rest may increase risk of venous thrombosis.)
  6. Consider prophylactic Amoxicillin if hypoalbuminemia
  7. Steroids
  8. Diuretics, if severely fluid overloaded
  9. Pneumococcal vaccine, if available, and not previously immunized

Management - relapses

The same as above, except

Follow up

In renal clinic


In minimal change disease the prognosis is good. Other causes of glomerulonephritis may progress to end stage kidney disease, especially if no response on treatment.


  1. Steroid resistant NS: after 8 weeks of daily steroids at 2mg/kg the patient is still nephrotic
  2. Frequently relapsing NS: able to wean steroids and/or stop steroids, but the patient relapses either twice in 6 months or four times in a year
  3. Steroid dependant NS: Patient responds to steroids and remits, but unable to stop steroids