Paediatric Nephrology MCQs

Explanation: The clinical features: significant proteinuria (3+), hypoalbuminemia, and edema; are characteristic of Nephrotic Syndrome . In children aged 2-8 years, the most common histopathological diagnosis is Minimal Change Disease (MCD) . Absence of hematuria and hypertension supports the diagnosis of idiopathic nephrotic syndrome. Light microscopy typically shows minimal or no changes. Electron microscopy reveals effacement of podocyte foot processes. Oliguria , although more typical of nephritic syndrome, may occur in nephrotic syndrome due to worsening edema and hypoalbuminemia. Explanation of Other Options: IgA nephropathy (Option B): Presents with hematuria, often post-infectious. Membranous nephropathy (Option C): More common in adults; shows thickened GBM on microscopy. FSGS (Option D): Presents with steroid-resistant nephrotic syndrome and may show hematuria or hypertension.

The child's presentation is consistent with idiopathic nephrotic syndrome. Nephrotic syndrome results from urinary protein losses, which lead to hypoalbuminemia. The hypoalbuminemia leads to dependent edema. As such, the edema may be most noticeable around the eyes in the mornings with a shift to the lower extremities as the day progresses. Hypertension may occasionally be present. Typical laboratory findings include serum hypoalbuminemia, proteinuria, and hyperlipidemia. Idiopathic nephrotic syndrome is the most common cause of nephrotic syndrome in childhood. Reference: OP Ghai 10 th Edition, Pages 500-501; Nelson textbook of pediatrics, 1 st SA ed., pg. 2523

Nephrotic range proteinuria is defined as proteinuria >3.5 g/24 hour or a urine protein : creatinine ratio >2. The triad of clinical findings associated with nephrotic syndrome arising from the large urinary losses of protein are hypoalbuminemia (≤2.5 g/dL), edema, and hyperlipidemia (cholesterol >200 mg/dL). Reference: Nelson textbook of Pediatrics, 20 th ed., pg. 2521

Minimal Change Disease is a histopathological entity commonly seen in children with nephrotic syndrome. The disease is so-named because the light microscopy shows minimal to no change. However, electron microscopy shows effacement of foot process of podocytes. Let us evaluate each option Option A is False. Minimal change disease is more common in boys than girls Option B is False. It causes selective proteinuria Option C is True. MCD leads to excess albumin loss in urine, causing severe hypoalbuminemia and is thus the MC cause of childhood nephrotic syndrome. Option D is False. Most cases respond well to Oral Prednisolone as the first line therapy. Reference: OP Ghai 10 th Edition, Pages 500-501.

Presence of low complement level indicates complement-mediated injury, which is a feature of glomerulonephritis like PSGN, but is not seen in Nephrotic Syndrome. Regarding other options Option A is True. Hypertension can sometimes occur in Nephrotic syndrome, but is more commonly a feature of acute nephritic syndrome Option B is True. Minimal Change Disease tends to occur in age 2-8 years Option C is True. Massive proteinuria is a hallmark of nephrotic syndrome Reference: OP Ghai 10 th Edition, Pages 500-501

The child in the case has Nephrotic syndrome characterised by selective proteinuria of albumin. It is more common in the paediatric population. Minimal change disease is the most common type in children. Light microscopy is normal in minimal change disease. Electron microscopy will show effacements of podocytes. It shows excellent response to oral prednisolone. Reference: OP Ghai 10 th Edition, Pages 500-501; Nelson textbook of Pediatrics, 20 th ed, pg. 2521

Following close contact with varicella infection, give immunocompromised children on immunosuppressive agents varicella-zoster immune globulin if available ; immunize healthy household contacts with live vaccines to minimize the risk of transfer of infection to the immunosuppressed child, but avoid direct exposure of the child to gastrointestinal or respiratory secretions of vaccinated contacts for 3-6 weeks after vaccination. Live vaccines are contraindicated for this child. ( Option A) IV acyclovir is recommended by some literature. ( Option C) KEY TAKEAWAYS: Live vaccines are contraindicated in patients with nephrotic syndrome. Tags: Topic: NEPHROTIC SYNDROME Difficulty level: MUST KNOW PYQ: NEET PG 2022; 2021; FMGE JAN 2023; DEC 2020 Reference: Nelson textbook of Pediatrics, 21 st ed., pg. 2753

Both Bartter Syndrome & Gitelman Syndrome have hypokalemia and thus serum potassium levels can't be used to distinguish between them. Regarding other options Option B- Bartter Syndrome shows hypercalciuria while Gitelman Syndrome shows Hypocalciuria Option C- Serum Mg is normal in Bartter and low in Gitelman Option D- Facial dysmorphism occurs in some forms of Bartter syndrome but not in Gitelman syndrome Reference: OP Ghai 10 th Edition, Page 525; Nelson 21 st Edition, Chapter 549