A 3-year-old has generalised oedema, urine protein 4+ and serum albumin 18 g/L. What is the most likely diagnosis and initial treatment?
Answer and explanation
Correct answer: C. Minimal change nephrotic syndrome, treated with oral prednisolone
- Step 1: Heavy proteinuria, low albumin and oedema in a young child suggest nephrotic syndrome.
- Step 2: Most childhood cases are steroid-responsive minimal change disease.
Answer
Minimal change nephrotic syndrome, treated with oral prednisolone.
Why not the others: Acute post-streptococcal glomerulonephritis, treated with fluids and a thiazide diuretic: Glomerulonephritis causes haematuria and hypertension. Congestive heart failure, treated with a beta-blocker and an ACE inhibitor: Heart failure does not give heavy proteinuria. Cow's milk allergy, treated with exclusion diet and a trial of antihistamines: Milk allergy does not cause nephrotic syndrome.
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