Q.17) What is the role of urinary EPP & 24 hrs urine protein? When are they required?
A.17) Urinary electrophoresis was once recommended to distinguish nephrotic patients who are likely to respond to steroids from those who are less likely to respond i.e.steroid resistant cases using selectivity index i.e. ratio of urinary albumin to urinary IgG or transferrin. But since there is an overlap and no clear cut differences reported between responsive and non responsive cases, this test is not recommended in practice. As regards 24 hours urinary protein excretion, to measure exact amount of protein loss is difficult in young children because of difficulty in actual collection of all samples of urine. Recently urinary protein:creatinine ratio in a spot sample of urine is found to be equally useful.

Q.18) When do you give diuretics in NS? When is Albumin given?
A.18) Diuretic (Lasix) is only given to those patients who have severe oedema with oliguria or high BP. Similarly IV Albumin followed by IV Lasix given to severely oedematous nephrotics by experienced paediatricians in specialised centers.

Q.19) How do you screen for complications of Spontaneous Bacterial Peritonitis and how to you treat it?
A.19) Peritonitis is a common major infection in Nephrotic syndrome of childhood, which can even cause mortality if not diagnosed early enough. Usually it presents as distension of abdomen because of accumulation of infected fluid in the peritoneum, which is the covering of the intestines. The other manifestations like fever, pain and vomiting may be absent. Hence, the diagnosis is difficult if not suspected in a child with distension of abdomen and active NS. It becomes mandatory to tap this fluid by inserting the needle in the abdomen and send it for examination for presence of pus cells and organisms. It can be treated successfully by giving intravenous antibiotics for 7-10 days. Obviously, it can be treated only in a hospital. Recurrence of peritonitis is again a big problem and some of the organisms responsible for peritonitis can be prevented by vaccination. Pneumococcal and HIB vaccine are recommended when the child is off steroids and does not have active NS.

Q 20) What are the long-term consequences of NS?
A 20) Majority (75-80%) of children who begin their nephrotic syndrome between 2-6 years of age do not progress to kidney failure and grow into normal adults. Those who relapse stop relapsing by adolescence and puberty. Hence, the outcome of nephrotic syndrome is essentially good.



Last updated on 6-11-2000