Nephrotic syndrome and arthritis in a 12-year-old girl.

NEPHROTIC SYNDROME (NS) in a 12year-old girl may present a diagnostic problem concerning the underlying disease. NS in childhood may be primary or secondary. In childhood, the main cause of NS is minimal change disease. The peak age of minimal change disease is between the ages of 2 and 7 years.1 At 12 years of age, the incidence of idiopathic nephrotic syndrome has started to decrease. NS at this age may be attributable to other primary renal diseases, or it can be secondary to a rheumatic disease such as lupus, or secondary to an infection or malignancy. If there are accompanying extrarenal features such as arthritis and rash, the differential diagnosis also includes vasculitis. Other unusual causes of NS, such as secondary (AA-type) amyloidosis, are more common in certain geographic areas and ethnic groups. Secondary amyloidosis can be associated with juvenile idiopathic arthritis, familial Mediterranean fever, or chronic suppurative infections. A renal biopsy to establish the diagnosis is indicated if the child’s condition is resistant to steroid treatment.

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