Nephrotic Syndrome in Children: Clinical Case and Viva QnA

Clinical Case of Nephrotic Syndrome in Children

Clinical Case: Nephrotic Syndrome in a 4-year-old Boy

A 4-year-old boy is brought to the pediatric clinic by his mother with complaints of generalized swelling of his body for the past week. The mother reports the following:

• Swelling started around the eyes and gradually progressed to involve the entire face, abdomen, and lower limbs
• Decreased urine output over the last 3 days
• No history of fever, joint pain, or skin rash
• No recent history of throat infection or any other illness
• No family history of kidney disease

On physical examination:

• Weight: 22 kg (increased from 18 kg at last well-child visit 2 months ago)
• Blood Pressure: 110/70 mmHg (slightly elevated for age)
• Generalized edema, most prominent in the periorbital region and lower extremities
• Distended abdomen with shifting dullness, suggestive of ascites
• No skin rash or joint swelling

Laboratory findings:

• Urinalysis: 4+ protein, no hematuria
• 24-hour urine protein: 2.8 g/m²/day (severe proteinuria)
• Serum albumin: 1.8 g/dL (hypoalbuminemia)
• Total cholesterol: 320 mg/dL (hypercholesterolemia)
• Serum creatinine: 0.4 mg/dL (normal)
• Complement C3 and C4 levels: Normal

Based on these findings, the child is diagnosed with Nephrotic Syndrome, likely Minimal Change Disease given his age and presentation. He is admitted for initiation of treatment with oral prednisolone and careful monitoring of fluid status and electrolytes.

Different Clinical Presentations of Nephrotic Syndrome in Children

Variety of Clinical Presentations in Pediatric Nephrotic Syndrome

1. Classic Presentation

   A 3-year-old girl presents with:

   • Sudden onset of periorbital edema, progressing to generalized edema
   • Weight gain
   • Decreased urine output
   • No hypertension or hematuria

2. Atypical Age Presentation

   A 14-year-old boy presents with:

   • Gradual onset of leg swelling and abdominal distention
   • Fatigue and loss of appetite
   • Mild hypertension
   • Microscopic hematuria on urinalysis

3. Infection-Associated Presentation

   A 5-year-old girl presents with:

   • Edema developing a week after a streptococcal throat infection
   • Low-grade fever
   • Gross hematuria
   • Hypertension

4. Rapid Progressive Presentation

   A 10-year-old boy presents with:

   • Rapid onset of severe edema and ascites over 2-3 days
   • Oliguria
   • Severe hypertension
   • Signs of fluid overload (tachypnea, crackles in lung bases)

5. Steroid-Resistant Presentation

   A 6-year-old girl presents with:

   • Persistent edema and proteinuria despite 4 weeks of steroid therapy
   • Progressive azotemia
   • Hypertension
   • Family history of kidney disease

Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

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