What is included in the long-term monitoring of pediatric nephrotic syndrome?

Updated: Mar 04, 2020
  • Author: Jerome C Lane, MD; Chief Editor: Craig B Langman, MD  more...
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Answer

Ambulatory monitoring of the child's condition and response to treatment is a very important aspect of the overall management of nephrotic syndrome.

Home monitoring of urine protein and fluid status is an important aspect of management. Parents and caregivers should be trained to monitor first-morning urine proteins at home with urine dipstick. Weight should be checked every morning as well and a home logbook should be kept recording the patient’s daily weight, urine protein, and steroid dose if the child is receiving steroids.

Families and patients are instructed to call for any edema, weight gain, or urine testing of 2+ or more for protein for more than 2 days. Rapid detection of relapse of proteinuria by home testing of urine can allow early initiation of steroid treatment before edema and other complications develop. Urine testing at home is also useful in monitoring response (or nonresponse) to steroid treatment.

Ishikura et al found that children with FRNS commonly suffer relapses following 2 years of cyclosporine treatment but nonetheless have a favorable prognosis with regard to renal function and overall survival. In the study, 46 patients who had participated as children in an earlier study, in which they had received 2 years of cyclosporine treatment, were followed up after a median period of 10.3 years subsequent to the start of that treatment. Twenty-three (50%) of the patients either had continued to experience frequent relapses over the follow-up period or else were receiving immunosuppressant therapy. None of the patients in the second study, however, suffered renal dysfunction or a lethal event during the follow-up period. [105]


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