Nephrotic syndrome is one of the commonest kidney diseases that we see in children and is usually a spot diagnosis. It is characterized by generalized anasarca, massive proteinuria, hypoalbuminemia and hypercholesterolemia.

Most children with nephrotic syndrome present between two to seven years of age. They usually do not have hematuria or hypertension. Although biopsy is usually not needed, the histopathology on light microscopy is practically normal. Hence it is called a minimal change disease

Atypical features include age of onset below one year  or above seven years , presence of hematuria, hypertension, raised serum creatinine, low serum C3 or extra renal involvement. When atypical features are present one may suspect a non-minimal change lesion or a secondary cause such as systemic lupus erythematosus or Henoch Schoenlein purpura.

1, Tests to establish the diagnosis include urine routine, serum albumin and serum cholesterol. 2 Tests for Renal function such as BUN and serum creatinine 3 Tests for infections include CBC, Mantoux test and X-ray chest. These should be done in all cases before starting steroid therapy.

The initial episode of nephrotic syndrome should be treated with steroids for 12 weeks. Prednisolone at a dose of 2 mg/kg per day in divided doses or as a single dose (maximum 60 mg daily) for 6 weeks, followed by 1.5 mg/kg (maximum 40 mg) as a single morning dose on alternate days for the next 6 weeks; therapy is then discontinued.

• Age of onset < 1 year
• Hematuria, Hypertension, raised creatinine or extra renal involvement
• Refractory edema
• Positive family history
• Steroid resistant nephrotic syndrome