A toddler is being followed up after corticosteroid treatment for minimal change nephrotic syndrome (MCNS). Which finding is an early sign of relapse?

• A. Albuminuria
• B. Hyperglycemia
• C. Elevated blood pressure
• D. Decreased urine output

Answer: (A)

Relapse in minimal change nephrotic syndrome is first signaled by the return of protein loss in the urine, i.e., albuminuria. This reflects renewed increased permeability of the glomerular barrier and occurs before serum albumin falls enough to cause noticeable edema or before blood pressure changes or reduced urine output appear. Monitoring urine for protein provides the earliest clue that the disease is flaring again. Steroid side effects like hyperglycemia can occur but are not relapse indicators, and while high blood pressure or decreased urine output can accompany relapse, they aren’t the earliest marker.