My baby has facial swelling, and her urine report shows proteinuria. Kindly help.

Question

Hello doctor,

My baby has swelling in the face lasting for a week. We consulted our family physician, and urinalysis showed proteinuria. She was born full-term from her first normal pregnancy. Birth weight is 3040 g, and the Apgar score is 9/10. She is breastfed, and we observed bloody mucus in feces since birth, and investigated due to failure to thrive, and diagnosed with a wheat allergy.

Signs of atopic dermatitis were observed since the age of four months, which disappeared (including changes in feces) with an elimination diet. She is vaccinated according to the NIP. And has a history of previous respiratory infection.

Clinical examination:

Temperature is 97.9°F. The patient is alert and oriented. Length is 29.9 inches, and weight is 21.4 lbs.
No skin rashes are noted. No hyperemia of pharynx or tonsils. There is no redness of the pharynx or tonsils, and no peripheral lymphadenopathy is present. Periorbital edema is observed.
Heart rhythm is regular, with clear heart sounds and no murmurs. Blood pressure is 95/65 mmHg, and heart rate is 122 bpm.
Breath sounds are clear and equal bilaterally, with no crackles. Respiratory rate is 24 breaths per minute.
The abdomen is soft and non-tender. The liver is palpable at the right costal margin, and bowel sounds are normal.
No meningeal signs or focal neurological deficits are detected

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

As per your description and the reports, the child seems to be fitting into the nephrotic syndrome. Steroids will have to be started for the same, along with antibiotic cover for now. However, it is best to get the child evaluated physically by a nephrologist before starting steroids.

I hope this helps.

Kindly revert in case of further queries.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

We cannot be sure if it is a minimal change disease or not. To be sure of what type of nephrotic syndrome it is, a kidney biopsy is done. Generally, the first episode like this is treated with steroids after ruling out any renal infection. If these episodes keep repeating, then a kidney biopsy is done to find the actual cause of the nephrotic syndrome. Until then, it is considered an idiopathic nephrotic syndrome.

I hope this helps.

Kindly revert in case of further queries.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

We generally start with IV Methylprednisolone along with the cover of IV Ceftriaxone. However, this needs to be verified by a nephrologist before starting. The exact dose and how to taper need to be planned out by the nephrologist. During the course, the urine protein levels have to be monitored to see for changes or improvement.

I hope this helps.

Kindly revert in case of further queries.

Thank you.