Question

A 4-year-old with nephrotic syndrome completed the steroid course one week ago. On follow-up the urine dipstick shows trace protein; the child is asymptomatic with no edema. What is the clinical status?

• A. Relapse
• B. Remission
• C. Steroid-resistant nephrotic syndrome
• D. Steroid-dependent nephrotic syndrome

Hint:

Remission means nil or trace protein on dipstick, while relapse needs 3+ or 4+ protein for 3 days.

Answer 1

The Correct Option is B

Step 1: Understanding the question:
The child has nephrotic syndrome and has just finished a steroid course. Now the urine dipstick shows only trace protein and there is no edema. We have to name the disease status.
In childhood nephrotic syndrome, status is always defined by the urine protein dipstick on early morning samples plus the clinical picture. The labels are remission, relapse, steroid dependent and steroid resistant.

Step 2: Recall the standard definitions:
Remission: urine albumin nil or trace (by dipstick) for 3 consecutive early morning samples.
Relapse: urine albumin 3+ or 4+ (or more than 40 mg/m2/hour) for 3 consecutive early morning samples, with or without edema.
Steroid dependent: two consecutive relapses while on alternate day steroids, or within 14 days of stopping steroids.
Steroid resistant: failure to reach remission despite 4 weeks of daily prednisolone at the standard dose (IAP guideline).

Step 3: Apply the definitions to this child:
The dipstick shows trace protein. That is the nil or trace range, which is the remission range.
The child has no edema and no symptoms, so the clinical picture also fits remission.
The child has already finished the steroid course and is now being followed up. So the disease responded to treatment and is not steroid resistant.

Step 4: Check option (A) Relapse:
A relapse needs heavy proteinuria, 3+ or 4+ on dipstick for 3 days in a row. Trace protein is far below this. So (A) is wrong.

Step 5: Check option (C) Steroid-resistant nephrotic syndrome:
Steroid resistance means proteinuria persists even after 4 weeks of daily steroids. This child has trace protein after finishing the course, so the urine cleared. So (C) is wrong.

Step 6: Check option (D) Steroid-dependent nephrotic syndrome:
Steroid dependence means the child relapses twice in a row while on alternate day steroids or within 14 days of stopping them. This child has not relapsed at all. The urine is nearly clear one week after stopping. So (D) is wrong.

Final Answer:
The child has nil or trace proteinuria, no edema, and a recent steroid course. This is remission, which is option (B). Relapse needs 3+ or 4+ protein, steroid dependence needs repeated relapses, and steroid resistance needs persistent proteinuria after 4 weeks of steroids.