Nephrotic Syndrome

September 14, 2005
Donald J. Kovacs, MD

For 1 week, a 22-month-old boy experienced gradually increasing facial swelling followed by swelling of the abdomen and legs. His mother reported that the child's urinary output had markedly decreased. During this period, the youngster gained 5 lb.

For 1 week, a 22-month-old boy experienced gradually increasing facial swelling followed by swelling of the abdomen and legs. His mother reported that the child's urinary output had markedly decreased. During this period, the youngster gained 5 lb.

The patient's blood pressure was 141/73 mm Hg; respiratory rate was 42 breaths per minute. Albumin level was 0.5 g/dL; cholesterol level, 353 mg/dL; and creatinine level, 0.2 mg/dL. Proteinuria was present.

Nephrotic syndrome was diagnosed. This disease affects children more frequently that adults; it is seen most often in boys younger than 5 years.

Dr Donald J. Kovacs of Boiling Springs, Pa, writes that the youngster was admitted to the hospital. Intravenous albumin, 25%, was initiated; furosemide and prednisone, 25 mg daily, were also given. This regimen was continued for 3 months and then tapered. The nephrosis quickly recurred.

During the following year, prednisone therapy was reinstituted; nephrosis recurred at each attempt to taper the drug.

Chlorambucil, 3 mg/d, was prescribed; despite a bout of leukopenia, the boy was able to complete a 3-month course of this drug.

A biopsy of the kidney was not performed; the presumed cause of this patient's nephrotic syndrome was minimal change glomerulonephritis-the most common cause of the nephrotic syndrome.

During the 3 years since the diagnosis was made, the youngster has had a few recurrences of nephrosis, which were successfully treated with brief courses of prednisone. He is otherwise medically healthy and developmentally normal. The long-range prognosis for this patient is good; as he gets older, the nephrotic syndrome may resolve completely.

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