EWJ Dec 2023 - Journal - Page 19
Most children respond well to treatment with
prednisolone, with the protein often disappearing
from their urine and the swelling going down within
a few weeks. This period is known as remission.
l 2+ – 100 to 300mg/dL
l 3+ – 300 to 1,000mg/dL
l 4+ – over 1,000mg/dL
The result for each day needs to be written down in a
diary for your doctor or specialist nurse to review
during your outpatient appointments.
Diuretics
Tablets that help you pee more (diuretics) may also be
given to help reduce the fluid build-up. They work by
increasing the amount of urine produced.
You should also note down the dose of any medication they're taking and any other comments, such as
whether your child's feeling unwell.
Penicillin
Penicillin is an antibiotic, and may be prescribed
during relapses to reduce the chances of an infection.
If the dipstick shows 3+ or more of protein in the
urine for 3 days in a row, this means your child is having a relapse. If this happens, you either need to follow the advice given about starting steroids or contact
your doctor.
Dietary changes
You may be advised to reduce the amount of salt in
your child's diet to prevent further water retention
and oedema.
Congenital nephrotic syndrome
Congenital nephrotic syndrome is usually caused by
an inherited faulty gene. For the condition to be
passed on to a child, both parents must have a healthy
copy of the gene and a faulty one.
This means avoiding processed foods and not adding
salt to what you eat.
Vaccinations
Children with nephrotic syndrome are advised to
have the pneumococcal vaccine. Some children may
also be recommended the varicella (chickenpox) vaccination between relapses. Live vaccines, such as
MMR, chickenpox and BCG, should not be given
while your child is taking medication to control their
symptoms.
Treating congenital nephrotic syndrome
If your child has congenital nephrotic syndrome,
they'll need frequent albumin infusions to help them
grow and develop normally. This often requires a stay
in hospital.
Sometimes parents can be trained to administer the
treatment at home.
Additional medication
Other medications may be used alongside or in place
of steroids if your child's remission cannot be maintained with steroids or they experience significant side
effects.
Additional medications that may be used include:
l levamisole
l cyclophosphamide
l ciclosporin
l tacrolimus
l mycophenolate
l rituximab
Dr Phil Mason
Consultant Nephrologist
BSc (Hons) PhD MB BS (Hons) FRCP.
Dr Philip Mason is a Consultant Nephrologist,
Albumin infusions
Most of the protein lost in nephrotic syndrome is a
type called albumin.
at Oxford Radcliffe Hospitals NHS Foundation
Trust and Hon Senior Lecturer at the
University of Oxford.
If your child's symptoms are severe, they may be
admitted to hospital to receive albumin infusions.
Dr Mason looks after the full range of renal,
dialysis and transplant patients with special interests in lupus,
vasculitis And transplantation.
Albumin is slowly added to the blood over a few hours
through a thin plastic tube called a cannula, which is
inserted into one of the veins in their arm.
Dr Mason is;
Clinical Lead for Nephrology, 2009-2017.
Lead for medical transplantation, 2005-present.
Caring for your child at home
If your child has been diagnosed with nephrotic
syndrome, you'll need to monitor their condition on a
daily basis to check for signs of relapses.
Lead for Antibody Incompatible Transplantation.
Medicolegal Work
Dr Mason has undertaken Medicolegal work since 1998.
Sample (anonymised) Reports available on request.
You'll need to use a dipstick to test your child's urine
for protein the first time they urinate each day.
Contact:
Sheila Otway - Secretary
The results of a dipstick test are recorded as either:
l negative – 0mg of proteinuria per decilitre of urine
(mg/dL)
l trace – 15 to 30mg/dL
l 1+ – 30 to 100mg/dL
EXPERT WITNESS JOURNAL
Tel: 01865 228659
Email: phil.mason@ouh.nhs.uk
Alternate Email: sheilaotway1@outlook.com
Oxford Kidney Unit, The Churchill Hospital, Oxford, OX3 7LE
17
DECEMBER 2023