A 4 years old child with nephritic syndrome is being treated with corticosteroid therapy. A nurse reviews the laboratory reports of the child's urine to evaluate if the treatment has been effective. Which of the following should decrease?

1. A

   Glycosuria

2. B

   Polyuria

3. C

   Proteinuria

4. D

   Hematuria

Appeared in: BHU NO-2019

Explanation

• The question most likely refers to nephrotic syndrome, as corticosteroids are the first-line treatment for this condition in children, particularly Minimal Change Disease.
• The hallmark of nephrotic syndrome is massive proteinuria (heavy protein loss in urine) due to increased permeability of the glomerular capillaries.
• Corticosteroids work by reducing glomerular inflammation and permeability, which directly targets the leakage of protein.
• Therefore, a decrease in proteinuria is the primary laboratory marker used to confirm that the therapy is effective and the disease is entering remission.

Why Other Options Were Wrong

• Option A: Glycosuria (glucose in urine) is not a feature of nephrotic syndrome. Corticosteroids can increase blood glucose as a side effect, which could potentially cause or worsen glycosuria.
• Option B: While diuresis (increased urine output, which could be termed polyuria) is a sign of resolving edema and recovery, it is a secondary effect. The primary measure of disease activity and treatment success is the reduction of protein leakage.
• Option D: Hematuria (blood in urine) is the characteristic sign of nephritic syndrome, not nephrotic syndrome. The treatment goal in the described scenario is to resolve proteinuria.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Evaluation of treatment effectiveness for pediatric nephrotic syndrome to guide bedside assessment, documentation, and the next nursing action.
• Nurses play a vital role in monitoring for proteinuria using urine dipsticks, which is essential for assessing treatment response and detecting relapse in children with nephrotic syndrome.
• Patient and family education is critical. Nurses must teach parents how to perform home urine testing for protein, monitor for signs of infection, and understand the importance of adhering to the corticosteroid regimen.
• What if? If the child on corticosteroids develops a fever and cough, the nurse must act immediately. Due to immunosuppression from the steroids, the child is at high risk for severe infection. This requires prompt assessment and reporting to the physician, as infection can trigger a relapse of nephrotic syndrome.

How to Approach the Question

• First, analyze the patient's details: a 4-year-old child.
• Next, identify the diagnosis and treatment: 'nephritic syndrome' treated with corticosteroids. Recognize that corticosteroid therapy is the standard for NEPHROTIC syndrome in this age group, suggesting a likely typo in the question.
• Recall the primary pathophysiology of nephrotic syndrome: massive proteinuria.
• Connect the treatment's mechanism (corticosteroids reduce glomerular permeability) to the expected outcome. The goal is to stop the protein leak.
• Evaluate the options: A decrease in proteinuria directly reflects the effectiveness of the treatment in correcting the underlying problem.
• Eliminate other options by considering their relationship to the disease and treatment. Glycosuria is a side effect, polyuria is a secondary sign of recovery, and hematuria is characteristic of a different syndrome.

Concept Tested & Keywords

• Concept Tested: Evaluation of treatment effectiveness for pediatric nephrotic syndrome.
• Stem keywords: 4 years old child, nephritic syndrome, corticosteroid therapy, evaluate treatment, urine
• Lead-in keywords: decrease
• Clinical cues: The combination of a young child, corticosteroid therapy, and a kidney disorder strongly suggests idiopathic nephrotic syndrome (Minimal Change Disease), despite the likely typo of 'nephritic'.

Question ID

Q78HdkHwRYT5vEDSrpYLbP

Copy ID

Reference Book

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 496-498

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1023-1025