postinfectious glomerulonephritis, MPGN, and lupus nephritis Additional studies to be considered include HIV, hepatitis B and C serologies in highrisk patients, and serum antinuclear antibodies, especially in children with symptoms of SLE or aged 10 years or more Management Given that there are two major processes leading to edema in nephrotic syndrome, arterial underfilling due to low oncotic pressure and primary renal sodium retention, management of fluid excess requires careful attention to the underlying causes Diuretic therapy would be effective in reducing edema and indicated if the primary process is renal sodium retention However, if hypoalbuminemia leads to decreased plasma volume via movement of fluid from the vascular space to the interstitium, diuretic therapy may aggravate arterial underfilling As it may be difficult to determine intravascular volume in patients with nephrotic syndrome, clinical characteristics that may predict intravascular volume status include GFR and serum albumin level Patients with decreased vascular volumes and severe hypoalbuminemia may require albumin infusions in conjunction with diuretics in order to maintain arterial filling pressures Children who present with severe edema should be admitted and may be treated with furosemide and albumin (e.g., 25% albumin) to achieve diuresis Albumin (0.5 to g/kg) infused over hours followed by one to two doses of furosemide (0.5 to mg/kg/dose) should result in fluid mobilization Providing albumin will bolster the intravascular oncotic pressure and safeguard against volume depletion during fluid mobilization Once the patent is stabilized, a plan for sodium and fluid restriction should be made Optimally, children are restricted to approximately to mEq/kg/day of sodium or up to a maximum of 2,000 mg/day in older children and adolescents Water restriction should be initiated given the release and action of ADH resulting in dilutional hyponatremia Admission for close volume management should be strongly considered if evidence of hypovolemia is apparent at presentation or uncontrolled fluid loss is anticipated (i.e., gastroenteritis) given the risk for thromboembolic complications and prerenal kidney injury Children with nephrotic syndrome who are hemodynamically stable should be started on daily prednisone at mg/kg or 60 mg/m2 after consultation with a nephrologist If they not require hospital admission for close fluid balance monitoring, they should be followed closely as an