A child with nephrotic syndrome on steroids and salt restriction has a dipstick showing 1+ protein, down from 3+ at the start of the episode. In consultation with the nephrologist, what is the correct course of treatment?

A child with nephrotic syndrome on steroids and salt restriction has a dipstick showing 1+ protein, down from 3+ at the start of the episode. In consultation with the nephrologist, what is the correct course of treatment?

• A. Begin a taper of the steroid medication while continuing salt restrictions.
• B. Continue with steroids and salt restrictions until the urine is negative for protein.
• C. Discontinue the steroids and salt restrictions now that improvement has occurred.
• D. Relax salt restrictions and continue administration of steroids until proteinuria is gone.

Answer: (D)

The main idea is to continue treatment to reach complete remission, not to stop therapy or clamp down on diet while there’s still protein in the urine. A dipstick showing 1+ protein means the child has had a good response but has not yet achieved full remission, so you don’t taper off steroids yet. Salt restriction is helpful for edema during the active phase, but as the child improves you can gradually liberalize salt intake rather than maintain strict restriction for the entire course. Therefore, the best approach is to continue the steroid treatment and progressively relax salt restrictions until the proteinuria resolves. Once remission is achieved, steroids can be tapered per protocol.

The main idea is to continue treatment to reach complete remission, not to stop therapy or clamp down on diet while there’s still protein in the urine. A dipstick showing 1+ protein means the child has had a good response but has not yet achieved full remission, so you don’t taper off steroids yet. Salt restriction is helpful for edema during the active phase, but as the child improves you can gradually liberalize salt intake rather than maintain strict restriction for the entire course. Therefore, the best approach is to continue the steroid treatment and progressively relax salt restrictions until the proteinuria resolves. Once remission is achieved, steroids can be tapered per protocol.