Nephrology Consultation Update Letter

Dear Dr Sarah Jenkins

Thank you for referring Leo Vance to our clinic.

Leo Vance was seen on 14/05/2024 for evaluation of recurrent periorbital oedema and heavy proteinuria.

Clinical Findings

Leo presented with a 10-day history of progressive periorbital and bilateral pedal oedema following a mild viral upper respiratory tract infection. On examination, his weight is 19.2 kg (up from a baseline of 17.5 kg), height is 105 cm, and BP is 98/62 mmHg. He has moderate periorbital puffiness and pitting oedema to the mid-shins, with no clinical ascites or pleural effusions. Cardiovascular and respiratory examinations are otherwise NAD. Urinalysis in clinic showed 4+ protein and negative blood, with a spot urine protein-to-creatinine ratio elevated at 450 mg/mmol. Blood tests revealed hypoalbuminaemia (serum albumin 18 g/L), normal renal function (creatinine 32 µmol/L, eGFR > 90 mL/min/1.73m²), and hypercholesterolaemia (total cholesterol 7.8 mmol/L). Complement levels (C3 and C4) and antistreptolysin O titres were normal.

Diagnosis

The clinical presentation and biochemical findings are consistent with a first presentation of idiopathic childhood nephrotic syndrome, most likely minimal change disease.

Management Plan

Leo has been commenced on high-dose corticosteroid therapy with prednisolone (Panafcortelone®) 40 mg PO daily (60 mg/m²/day) for 4 weeks, to be followed by 25 mg PO on alternate days (40 mg/m²/alternate day) for a further 4 weeks. To provide gastric protection while on high-dose steroids, he has been prescribed omeprazole (Losec®) 10 mg PO daily. His parents have been educated on daily home urine dipstick monitoring and instructed to maintain a no-added-salt diet with a modest fluid restriction of 1,000 mL per day until diuresis occurs. I have arranged a follow-up appointment in the Paediatric Nephrology Clinic in 2 weeks to assess his response to therapy.

Recommendations

Could you please monitor his blood pressure and weight weekly at your practice over the next month until he achieves remission. Please ensure he avoids any live attenuated vaccines while he remains on immunosuppressive doses of prednisolone. If he develops fevers, severe abdominal pain, or worsening generalised oedema despite compliance with treatment, please advise his parents to present directly to the Women's and Children's Hospital Emergency Department for urgent assessment.

Thank you again for the referral. Please contact me if any additional information is needed.

"Yours sincerely," Dr Marcus Thorne Consultant Paediatric Nephrologist Department of Paediatric Nephrology, Women's and Children's Hospital, 72 King William Rd, North Adelaide SA 5006 | Ph: (08) 8161 7000