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associated with oligoanuria and electrolyte disturbance, RRT may be
required until renal recovery is achieved.

NEPHROTIC SYNDROME
CLINICAL PEARLS AND PITFALLS
Nephrotic syndrome is characterized by edema, hypertension,
proteinuria, hypoalbuminemia, and hyperlipidemia.
The most common cause in childhood is minimal change disease
(MCD).
Patients may be intravascularly depleted despite signs of overall
fluid overload.
Children with nephrotic syndrome are at increased risk for serious
bacterial infections and thrombosis.

Current Evidence
Nephrotic syndrome is the clinical expression of a variety of glomerular
diseases and can be classified as primary (without evidence of systemic
illness), secondary, or congenital. Primary nephrotic syndrome includes
idiopathic nephrotic syndrome and nephrotic syndrome associated with
primary glomerulonephritis. Secondary nephrotic syndrome is associated
with systemic disorders such as chronic hepatitis B infection and SLE.
Nephrotic syndrome diagnosed within the first 3 months of life is termed
congenital nephrotic syndrome; when it is diagnosed between 3 and 12
months of life, it is called infantile nephrotic syndrome. Most of these
children have a genetic basis for renal disease. Congenital nephrotic
syndrome may also be due to intrauterine infection, such as congenital
syphilis, toxoplasmosis, CMV, human immunodeficiency virus, and other
organisms.
In children younger than 16 years, the annual incidence of nephrotic
syndrome is approximately 2 per 100,000. Presentation within the first year
of life is uncommon, and nephrotic syndrome within the first 3 months of

life should raise the suspicion for congenital nephrotic syndrome. Idiopathic
nephrotic syndrome is the most common form of childhood nephrosis with