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Q. When will swelling due to nephrotic syndrome in a baby reduce?

Answered by
Dr. Tarek Algamal
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Sep 05, 2019

Hello doctor,

My daughter, 2.8 years old was diagnosed with nephrotic syndrome. She had swelling in limbs, private part, stomach, and eyes. She also had slight cold during that time, but no running nose or cough. I have attached her reports.

From the last one week, we started medicine, post which the eye swelling (by 90 %), face, hand, legs have reduced and hand have also reduced, but the private part and stomach still have swelling. Overall swelling is still present. Urine check showed improved creatinine results after three days. Her weight has increased 1 kg from the last five days, everyday it is gradually increasing by 200 to 300 gm. Even prior to start of her treatment she had good appetite, she used to eat every few hour either a biscuit or yogurt or a fruit or bread slice.

My questions are:

In how many days does this swelling reduce?

The doctor here suggests albumin infusion if the weight continues to increase or the body swelling does not reduce by five more days. Is it safe to use albumin infusion? Does it require admission into hospital? How many days should we wait before we decide on albumin infusion? Any other alternate to albumin infusion to reduce edema? When will we know if the medicine is working, the doctor say it takes maximum of 30 to know the impact?

Whats happens if the child does not respond to the current medication, doctors here are not disclosing but I want to be prepared financially and mentally? What are the scenarios to take child immediately to hospital? Please help.

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Hello,

Welcome to icliniq.com.

I can see clearly that your daughter’s condition is improving (attachment removed to protect patient identity). This is the nephrotic syndrome of minimal change type as usually comes in the children. The reason behind less improvement in the private area and stomach edema is that steroids are causing central obesity and I believe that this is temporary and will subside when she tapers down the steroids (after remission of the disease).

Supposedly steroids are reducing the amount of protein filtered in the kidney and consequently, serum albumin will improve with time without the need for albumin infusion. We might use albumin infusion with diuretics when albumin in blood is less than 2 g/dL, if there is marked hypovolemia or acute pulmonary edema or renal failure. Usually, children are responding to the steroids within 2 to 4 weeks, then after remission, tapering down the dose over about six weeks.

Take your daughter to the hospital if there is marked shortness of breath or very low amount of urine or when she is severely unwell. Generally, the course of the disease is benign and it usually shows a good response to the treatment, I advise you to be patient with the doctors.


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