Approach to the infant or child with nephrotic syndrome

This figure summarizes our suggested approach to a child with nephrotic syndrome. Nephrotic syndrome in a child is defined as nephrotic range proteinuria and hypoalbuminemia. Refer to UpToDate's topics on nephrotic syndrome in children for additional details, including a discussion of the evidence supporting our approach.

NS: nephrotic syndrome; BUN: blood urea nitrogen; MCD: minimal change disease; SLE: systemic lupus erythematosus; HIV: human immunodeficiency virus; GN: glomerulonephritis.

* Potential complications include: hypertension, hematuria, hypovolemia, or rare complications such as bacterial or viral infection, thromboembolism, or pancreatitis.

¶ The first morning void/24-hour urine collection and serum albumin are used to confirm the diagnosis of NS. The remainder of the listed laboratory tests are used to assess for secondary causes or complications of NS.

Δ Extra-renal features suggestive of a congenital syndrome include: dysmorphic features, ambiguous genitalia, eye abnormalities, or developmental delays.

◊ Extra-renal symptoms suggestive of a secondary cause of NS include: malar rash, adenopathy, purpura, recent group A streptococcal infection of the skin or throat.

§ Other causes include: SLE, chronic hepatitis B or C, HIV, post-infectious GN, vasculitis, or genetic causes.

¥ Steroids for children <12 years of age who are in puberty may cause unwanted side effects. Kidney biopsy is warranted for these children.

Graphic 141345 Version 1.0

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Approach to the infant or child with nephrotic syndrome