Congenital nephrotic syndrome

A female infant born at 34 weeks' gestation after several days of ruptured membranes had a Potter-like face and compression-induced limb posture consi stent with oligohydramnios. Oedema developed on day 2; initial investigatio ns showed massive proteinuria, hypoalbuminaemia, hyponanaemia, acidosis and marked renal insufficiency. The infant was intubated and despite albumin i nfusion and intravenous antibiotics she became oligoanuric by day 8 and req uired haemofiltration. Renal biopsy at this stage showed cystic dilatation of tubules in the cortex and glomerular lesions consisting of shrunken tuft s with sclerotic centres and a corona of epithelial cells at the periphery. Due to a very poor prognosis treatment was withdrawn. Postmortem examinati on of the kidneys confirmed the histological diagnosis of diffuse mesangial sclerosis. Genetic studies found no mutations in WT1 and NPHS1 genes altho ugh the entire genes could not be screened for mutations due to lack of DNA .