Dr. Faisal Abdul Karim Malim
Pediatrics
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Patient's Query
Hello doctor,
My baby has swelling in the face lasting for a week. We consulted our family physician and urinalysis showed proteinuria. She is born full-term from her first normal pregnancy. Birth weight is 3040 g, and 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 that 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:
T - 36.6 C. Alert and oriented. Length 76 cm, weight 9.7 kg.
No rashes.
No hyperemia of pharynx or tonsils.
No peripheral lymphadenopathy.
Periorbital edema seen.
Heart rate rhythmical, heart sounds clear with no murmurs.
BP 95/65 mmHg. HR 122 bpm.
Breathing sounds clear and symmetrical, with no crackles.
RR 24 bpm.
Abdomen is soft and non-tender.
Liver is at the right rib cage.
Normal peristalsis.
No meningeal or focal neurologic signs.
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.
Patient's Query
Thank you doctor,
Can it be nephrotic minimal disease change?
Hello,
Welcome back to icliniq.com.
We cannot be sure if it is a minimal change disease or no. 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.
Patient's Query
Thank you doctor,
So what steroids and antibiotics can be prescribed?
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 needs to be planned out by the nephrologist. During the course, the urine protein levels have to be monitored to see for changes or improvement.
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Pediatrics
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