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Nephrotic Syndrome — RACP Paediatrics MCQ

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HardNephrologyNephrotic SyndromeRACP Paediatrics

A 5-year-old admitted with nephrotic syndrome has massive oedema, abdominal discomfort, tachycardia, cool peripheries, oliguria and serum albumin 12 g/L. There are no basal crackles. Which oedema strategy is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Give 20% albumin 5 mL/kg over 4 hours, with monitoring and optional IV furosemide

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · E = shown as D · A = shown as E

B is correct. The child is oedematous but intravascularly depleted. RCH advises concentrated albumin 20%, 5 mL/kg (1 g/kg) over four hours for intravascular depletion or severe symptomatic oedema, with close observation for hypertension and pulmonary oedema; furosemide may be considered during or after infusion. C can worsen depletion, acute kidney injury and thrombosis when loop diuretic is used alone. D gives concentrated albumin dangerously fast and omits observation. E worsens total-body fluid excess and uses a weak diuretic strategy. A neither restores effective circulating volume nor manages symptomatic oedema. Total fluid is usually restricted to 50–70% maintenance, individualised to clinical volume status.

Reference: Royal Children’s Hospital Melbourne: Nephrotic syndrome: https://www.rch.org.au/clinicalguide/guideline_index/nephrotic_syndrome/