Disorder characterised by loss of protein in the urine due to damage of the kidney. It is common in children.
Causes
- Idiopathic/unknown (majority of cases)
- Congenital (rare)
- Secondary: Due to post-streptococcal acute glomerulonephritis, malaria, allergy, UTI, hepatitis B, HIV
Clinical features
- Generalised oedema
- Severe loss of protein in urine (proteinuria)
- Low protein (albumin) levels in the blood serum (hypoalbuminaemia)
- Hyperlipidaemia (high blood cholesterol)
Investigations
- As for Acute glomerulonephritis plus
- 24 hour urine protein quantification or Albumin creatinine ratio (ACR)
- Serum protein and cholesterol
Differential diagnosis
- Cardiac failure, liver disease
- Malnutrition with oedema e.g. kwashiorkor
- Malabsorption syndrome
- Allergic states causing generalised body swelling
- Chronic glomerulonephritis
Management<
- Restrict salt intake (<2 g daily, i.e. less than a half teaspoon/day)
- Restrict water/fluid intake
- Both salt and water/fluid intake should be moderated until diuresis is induced and swelling
is subsiding, which can take several weeks
- Both salt and water/fluid intake should be moderated until diuresis is induced and swelling
- Furosemide 40-80 mg each morning to induce diuresis
Child: 1-2 mg/kg per dose (but see notes below) - Prednisolone 2 mg/kg daily (max: 60 mg)
- Continue until no further proteinuria (around 6 weeks)
- Gradually reduce the dose after the first 4 weeks, e.g. reduce by 0.5 mg/kg per day each week
When oedema has subsided and if still hypertensive
- Give appropriate treatment
If clinical signs of/suspected streptococcal infection:
- Give antibiotic as in Acute glomerulonephritis
If patient from area of endemic schistosomiasis
- Praziquantel 40 mg/kg single dose
If no improvement after 4 weeks or patient relapses
- Refer for further management