Nephrotic syndrome in 3's (mostly)

Sorry I have been quiet for a while, I've had to finish off my paediatric project. Onto allergy and immunology now so maybe a few articles focussing on that area. Anyway, before I finished paediatrics a nephrology registrar kindly sat me down and gave me a brief overview of nephrotic syndrome. I've always been confused by it so it was nice to have it summarised for me. Hope it helps. 

Triad:

- proteinuria (albumin, IgG's, clotting factors)

- hypoalbuminaemia

- oedema

Presentation (usually 2-6yrs):

- oedema

- spontaneous bacterial peritonitis

- hypovolaemic shock

Complications:

- oedema

- infections

- thrombosis

Causes:

- minimal change

- focal-segmental

- others (lupus, vasculitis, MPGN)

Investigations:

- urine electrolytes (decreased urine Na)

- biopsy

Management:

- low salt diet

- IV albumin + furosemide

- steroids

- penicillin V + ranitidine

Steroids:

- 1/3 steroid sensitive

- 1/3 steroid sensitive, but with relapses

- 1/3 steroid resistance nephrotic syndrome

Second line therapies:

- MMF

- tacrolimus

- cyclophosphamide

- rituximab

- levamisole