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What is True about Nephrotic syndrome in a child – a) Minimal change disease is commonest causeb) Proteinuria of 4 gm/m2 hr is characteristicc) Cyclosporine & Azathioprine is mainstay of therapyd) Pretreatment biopsy is done in all casese) Spontaneous bacterial peritonitis is associated with it and explain in detail?
Nephrotic syndrome in children

Most children (90%) with nephrotic syndrome have a form of idiopathic nephrotic syndrome.
Causes of idiopathic nephrotic syndrome are -

i) Minimal change disease (85%)           
ii) Mesangial proliferative GN           
 iii) FSGS

Infections are a common complication of minimal change disease (Nephrotic syndrome)
Commonly seen infections are - Spontaneous bacterial peritonitis (most common), UTI, Sepsis, pneumonia and cellulitis.
There is increased susceptibility to infections in minimal change disease because of -
Urinary losses of immunoglobulin’s & properdin factor B  
Malnutrition     
Defective cell-mediated immunity 
Oedema/ascites
Immunosuppressive therapy
The bacteria most commonly implicated in these cases are Streptococcus pneumoniae (most common) and E. coll.