Nephrosis: Early symptoms and diagnosis
The condition may develop gradually. The swelling due to fluid retention may at first go unnoticed. It often seems that the child looks heavier and this may be attributed to eating better.
One of the earliest signs is “puffiness” of the face or swelling around the eyes, usually noticed in the morning when the child first awakens, but often subsiding later in the day. Initially the swelling of the eyelids may be attributed to "allergies," but, in the case of the child with nephrosis, it is due to that condition.
As the disease continues, the swelling becomes more persistent around the eyes, the face, the abdomen and the legs. Some boys may have swelling of the penis and the scrotum; girls may have swelling of the labia. It may appear that clothes no longer seem to fit .A belt or socks may leave an indentation in the skin. A doctor examining your child will press the skin of the lower leg above the ankle. After removing the pressure, the persistence of an indentation is a clue to the retention of excess fluid beneath the skin and is referred to as “pitting edema.” Fluid retention is reversible and can be treated by changes in diet and medications .
The kidney disease itself does not cause pain although some children may complain of a stomach ache. Bed-wetting or a burning sensation during urination are not features of nephrosis. If they occur it is most likely coincidental. Nephrosis does not affect the bladder; therefore, it is not necessary for the child to be examined by an urologist.
Sometimes a kidney biopsy is necessary
In many children, there may be no question about the diagnosis, and a biopsy is not necessary. However, some children do not seem to have the typical signs of minimal-change nephrotic syndrome, and it may not be appropriate to begin treatment with prednisone without first having an accurate diagnosis. (More here about treatment.) Therefore, to confirm the diagnosis as precisely as possible or to help guide treatment, a physician may recommend that a kidney biopsy be done.
Some children with frequent relapses may be candidates for immunosuppressive medications. (More about relapses here.) A kidney biopsy is usually done before beginning such medications .Another reason for doing a biopsy is the persistence of proteinuria despite treatment with prednisone for several weeks. The failure to respond to treatment with prednisone is also a reason to consider doing a kidney biopsy. The biopsy procedure itself is not an operation; it takes approximately 30 minutes and does not leave a permanent large scar.
A kidney (renal) biopsy involves inserting a biopsy needle into the kidney, usually with the child sedated and always after first numbing the skin over the back with a local anesthetic. A tiny piece of tissue about 1/16 inch thick and 1/2 to 1 inch in length is removed by the needle and is sent to a pathologist for examination. Although this tiny piece of tissue is quite small, it is enough of a specimen to be examined using a special microscope. The pathologist can then determine exactly what changes or damage may have occurred. The processing and examination of kidney tissue takes several days.
If a kidney biopsy is necessary, overnight hospitalization may be necessary. It is important that the initial treatment with prednisone be under the supervision of a pediatric kidney disease specialist (pediatric nephrologist) or an experienced pediatrician. After discharge from the hospital, frequent phone contact or regular outpatient visits are important.