Morning Rounds \u00b7 Paediatric Nephrotic Syndrome<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n\/* \u2500\u2500 All styles are namespaced to #mrq01 so they don't\n bleed into the WordPress theme around this HTML block \u2500\u2500 *\/\n#mrq01 *,#mrq01 *::before,#mrq01 *::after{box-sizing:border-box;margin:0;padding:0}\n#mrq01{\n \/* \u2500\u2500 Colour palette \u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\n Soothing teal-blue in place of terracotta.\n To change the accent colour, replace #2A6E8A (steel teal)\n in these three lines and the conic-gradient in showScore() JS *\/\n --ter:#2A6E8A;\n --ter-light:#3A8EAA;\n --ter-pale:#E6F3F8;\n 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text-anchor=\"middle\" fill=\"#4A7A9A\" font-size=\"10\" font-family=\"Georgia,serif\" font-weight=\"bold\">NORMAL<\/text>\n <text x=\"425\" y=\"18\" text-anchor=\"middle\" fill=\"#4A7A9A\" font-size=\"10\" font-family=\"Georgia,serif\" font-weight=\"bold\">MINIMAL CHANGE DISEASE<\/text>\n\n \n\n \n <rect x=\"15\" y=\"90\" width=\"240\" height=\"18\" rx=\"3\" fill=\"#C5D8E8\" opacity=\"0.8\"\/>\n <text x=\"135\" y=\"101\" text-anchor=\"middle\" fill=\"#2A5A7A\" font-size=\"8\" font-family=\"Georgia,serif\">GBM<\/text>\n\n \n <rect x=\"15\" y=\"108\" width=\"240\" height=\"14\" rx=\"2\" fill=\"#A8C8E0\" opacity=\"0.5\"\/>\n <text x=\"135\" y=\"118\" text-anchor=\"middle\" fill=\"#2A5A7A\" font-size=\"7.5\" font-family=\"Georgia,serif\" font-style=\"italic\">fenestrated endothelium<\/text>\n\n \n <ellipse cx=\"135\" cy=\"62\" rx=\"52\" ry=\"18\" fill=\"#B8D8F0\" opacity=\"0.7\"\/>\n <text x=\"135\" y=\"65\" text-anchor=\"middle\" fill=\"#1A4A6A\" font-size=\"8\" font-family=\"Georgia,serif\">podocyte cell body<\/text>\n\n \n \n <rect x=\"32\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"52\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"72\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"92\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"112\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"132\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"152\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"172\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"192\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"212\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n\n \n <line x1=\"44\" y1=\"80\" x2=\"52\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"64\" y1=\"80\" x2=\"72\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"84\" y1=\"80\" x2=\"92\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"104\" y1=\"80\" x2=\"112\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"124\" y1=\"80\" x2=\"132\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"144\" y1=\"80\" x2=\"152\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"164\" y1=\"80\" x2=\"172\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"184\" y1=\"80\" x2=\"192\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"204\" y1=\"80\" x2=\"212\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n\n \n <text x=\"135\" y=\"155\" text-anchor=\"middle\" fill=\"#3A7A9A\" font-size=\"8\" font-family=\"Georgia,serif\">foot processes interdigitated<\/text>\n <text x=\"135\" y=\"166\" text-anchor=\"middle\" fill=\"#3A7A9A\" font-size=\"8\" font-family=\"Georgia,serif\">slit diaphragm intact<\/text>\n <text x=\"135\" y=\"180\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Normal filtration barrier<\/text>\n\n \n\n \n <rect x=\"305\" y=\"90\" width=\"240\" height=\"18\" rx=\"3\" fill=\"#C5D8E8\" opacity=\"0.8\"\/>\n <text x=\"425\" y=\"101\" text-anchor=\"middle\" fill=\"#2A5A7A\" font-size=\"8\" font-family=\"Georgia,serif\">GBM (normal on LM)<\/text>\n\n \n <rect x=\"305\" y=\"108\" width=\"240\" height=\"14\" rx=\"2\" fill=\"#A8C8E0\" opacity=\"0.5\"\/>\n <text x=\"425\" y=\"118\" text-anchor=\"middle\" fill=\"#2A5A7A\" font-size=\"7.5\" font-family=\"Georgia,serif\" font-style=\"italic\">fenestrated endothelium<\/text>\n\n \n <ellipse cx=\"425\" cy=\"62\" rx=\"52\" ry=\"18\" fill=\"#B8D8F0\" opacity=\"0.7\"\/>\n <text x=\"425\" y=\"65\" text-anchor=\"middle\" fill=\"#1A4A6A\" font-size=\"8\" font-family=\"Georgia,serif\">podocyte cell body<\/text>\n\n \n <rect x=\"322\" y=\"68\" width=\"244\" height=\"22\" rx=\"5\" fill=\"#7AB8D8\" opacity=\"0.85\"\/>\n\n \n <line x1=\"368\" y1=\"73\" x2=\"488\" y2=\"85\" stroke=\"#B83232\" stroke-width=\"1.8\" stroke-dasharray=\"4,3\" opacity=\"0.7\"\/>\n <text x=\"427\" y=\"80\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"7.5\" font-family=\"Georgia,serif\" font-style=\"italic\">slit diaphragm lost<\/text>\n\n \n <text x=\"425\" y=\"155\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"8\" font-family=\"Georgia,serif\">foot processes fused \/ effaced<\/text>\n <text x=\"425\" y=\"166\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"8\" font-family=\"Georgia,serif\">seen only on EM \u2014 LM is normal<\/text>\n <text x=\"425\" y=\"180\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">↑ protein leak → nephrotic syndrome<\/text>\n\n <\/svg>\n <figcaption>\n Electron-microscopy schematic. <strong>Normal<\/strong>: podocyte foot processes interdigitate with\n slit diaphragms intact \u2014 the primary barrier to protein. <strong>MCD<\/strong>: diffuse foot-process\n effacement obliterates the slit diaphragm; light microscopy and immunofluorescence remain\n <em>normal<\/em> \u2014 EM is the defining investigation.\n <\/figcaption>\n <\/figure>\n<\/div>\n\n\n\n<div id=\"mrq01\">\n\n \n <div class=\"mr-header\">\n <div class=\"mr-eyebrow\">Morning Rounds · Daily Clinical Quiz<\/div>\n <div class=\"mr-title\">\n Paediatric Nephrotic Syndrome<br><em>Clinical Reasoning<\/em>\n <\/div>\n <div class=\"mr-subtitle\">Five cases · Read carefully · Trust your instinct<\/div>\n <div class=\"mr-chips\">\n <span class=\"mr-chip\">5 Cases<\/span>\n <span class=\"mr-chip\">+4 \/ −1 scoring<\/span>\n <span class=\"mr-chip\">Options reshuffled<\/span>\n <\/div>\n <\/div>\n\n \n <div class=\"mr-sentinel\" id=\"mrq01-sentinel\"><\/div>\n\n \n <div class=\"mr-progress\" id=\"mrq01-progress\">\n <div class=\"mr-prog-inner\">\n <div class=\"mr-pips\" id=\"mrq01-pips\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"mr-body\">\n\n \n <div id=\"mrq01-cases\"><\/div>\n\n <div class=\"mr-submit-wrap\">\n <button class=\"mr-btn\" id=\"mrq01-submit\">Submit for Debrief<\/button>\n <\/div>\n\n \n <div class=\"mr-score\" id=\"mrq01-score\">\n <div class=\"mr-score-in\">\n <div class=\"mr-score-ey\">Round Complete<\/div>\n <div class=\"mr-ring\" id=\"mrq01-ring\">\n <div class=\"mr-ring-in\">\n <span class=\"mr-ring-pct\" id=\"mrq01-pct\">0%<\/span>\n <span class=\"mr-ring-sub\">net<\/span>\n <\/div>\n <\/div>\n <div class=\"mr-score-title\">Your Debrief<\/div>\n <div class=\"mr-score-net\" id=\"mrq01-net\"><\/div>\n <div class=\"mr-verdict\" id=\"mrq01-verdict\"><\/div>\n <div class=\"mr-bands\">\n <span class=\"mr-band mr-band-c\" id=\"mrq01-ct-c\"><\/span>\n <span class=\"mr-band mr-band-w\" id=\"mrq01-ct-w\"><\/span>\n <span class=\"mr-band mr-band-s\" id=\"mrq01-ct-s\"><\/span>\n <\/div>\n <button class=\"mr-retry\" id=\"mrq01-retry\">↻ New Round<\/button>\n <\/div>\n <\/div>\n\n <\/div>\n<\/div>\n\n\n<script>\n(function () {\n 'use strict';\n\n \/* \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n NAMESPACE \u2014 one string that prefixes every element id.\n If you ever put two quizzes on the same page, change\n 'mrq01' to 'mrq02' in one of them (and update every\n id=\"mrq01-...\" in the HTML above to match).\n \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 *\/\n var NS = 'mrq01';\n var TOTAL = 5;\n var MAX = 20; \/* TOTAL \u00d7 4 \u2014 update if you ever change TOTAL *\/\n var LTRS = ['A','B','C','D'];\n\n\n \/* \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n \u2605 EDIT HERE \u2605 \u2014 THE QUESTION BANK\n \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n\n QS is an array of 5 question objects.\n Each object has these fields:\n\n id \u2014 question number 1\u20135. Keep in order. Don't skip.\n\n tag \u2014 short topic label shown above the stem in small caps.\n\n stem \u2014 the question text. HTML tags allowed inside the string.\n\n correct \u2014 EXACT text of the correct option.\n Must match one of the entries in opts, character for character.\n\n opts \u2014 array of exactly 4 answer strings (shuffled on every load).\n\n exp \u2014 explanation shown after the user answers (3\u20135 sentences).\n\n imgId \u2014 'mrq01-img1' to show the image; null to show nothing.\n Only set on ONE question.\n\n \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 *\/\n var QS = [\n\n \/* \u2500\u2500 Question 1 \u2500\u2500 *\/\n {\n id: 1,\n tag: 'Histopathology — Diagnosis',\n stem: 'A <strong>4-year-old boy<\/strong> presents with periorbital puffiness for one week, worse on waking, and progressive bilateral leg oedema. Urine dipstick shows <strong>3+ protein<\/strong> with no blood. Serum albumin is <strong>1.7 g\/dL<\/strong>, cholesterol is elevated, and complement C3 is normal. Light microscopy of a renal biopsy shows <em>no abnormality<\/em>; immunofluorescence is negative. Which underlying ultrastructural finding on electron microscopy confirms the diagnosis?',\n correct: 'Diffuse effacement of podocyte foot processes with loss of the slit diaphragm',\n opts: [\n 'Diffuse effacement of podocyte foot processes with loss of the slit diaphragm',\n 'Segmental sclerosis and hyalinosis affecting a proportion of glomeruli',\n 'Subepithelial electron-dense deposits producing a spike-and-dome pattern',\n 'Mesangial and subendothelial immune complex deposits with GBM duplication'\n ],\n exp: '<strong>Minimal Change Disease (MCD)<\/strong> accounts for approximately 90% of nephrotic syndrome in children aged 1–8 years. Light microscopy and immunofluorescence are characteristically <em>normal<\/em>; the diagnostic lesion is <strong>diffuse podocyte foot-process effacement<\/strong> seen only on electron microscopy. This disrupts the slit diaphragm, abolishing the charge and size barrier to albumin. C3 is normal (unlike MPGN or lupus nephritis). MCD is exquisitely steroid-sensitive: over 90% of children achieve remission with prednisolone.',\n imgId: 'mrq01-img1'\n },\n\n \/* \u2500\u2500 Question 2 \u2500\u2500 *\/\n {\n id: 2,\n tag: 'Treatment — First Episode',\n stem: 'A <strong>5-year-old girl<\/strong> presents with her first episode of nephrotic syndrome. There is no haematuria, blood pressure is normal for age, serum C3 is normal, and there are no clinical features to suggest a secondary cause. She has no contraindications to steroids. According to <strong>ISKDC guidelines<\/strong>, what is the recommended first-line regimen?',\n correct: 'Oral prednisolone 60 mg\/m²\/day (max 60 mg) for 4 weeks, then 40 mg\/m² on alternate days for 4 weeks',\n opts: [\n 'Oral prednisolone 60 mg\/m²\/day (max 60 mg) for 4 weeks, then 40 mg\/m² on alternate days for 4 weeks',\n 'IV methylprednisolone pulses 1 g\/1.73 m² for 3 days followed by oral prednisolone',\n 'Oral cyclophosphamide 2–3 mg\/kg\/day for 12 weeks as initial therapy',\n 'Cyclosporine 4–5 mg\/kg\/day in two divided doses with trough monitoring'\n ],\n exp: 'The <strong>ISKDC protocol<\/strong> for a first episode of childhood nephrotic syndrome is <strong>oral prednisolone 60 mg\/m²\/day<\/strong> (maximum 60 mg) for 4 weeks, followed by <strong>40 mg\/m²<\/strong> on alternate days for a further 4 weeks. A favourable response to steroids effectively confirms MCD without the need for a biopsy. IV methylprednisolone, cyclophosphamide, and cyclosporine are reserved for steroid resistance, frequent relapsers, or steroid-dependent disease. Renal biopsy at first presentation is not routinely indicated in a school-age child with a typical clinical picture.',\n imgId: null\n },\n\n \/* \u2500\u2500 Question 3 \u2500\u2500 *\/\n {\n id: 3,\n tag: 'Relapse — Classification',\n stem: 'A <strong>6-year-old boy<\/strong> achieved remission after his first episode of nephrotic syndrome with standard steroid therapy. He was off steroids for 3 months when his mother noticed facial puffiness returning. Urine dipstick shows <strong>3+ protein on three consecutive mornings<\/strong>. Over the past 10 months he has had <em>two relapses including this one<\/em>, both occurring more than 4 weeks after stopping steroids. How is this episode best classified, and what is the appropriate next step?',\n correct: 'Infrequent relapser — treat with prednisolone 60 mg\/m²\/day until remission, then taper',\n opts: [\n 'Infrequent relapser — treat with prednisolone 60 mg\/m²\/day until remission, then taper',\n 'Frequently relapsing nephrotic syndrome — add levamisole or low-dose alternate-day steroids',\n 'Steroid-dependent nephrotic syndrome — start cyclosporine immediately',\n 'Steroid-resistant nephrotic syndrome — perform renal biopsy before retreating'\n ],\n exp: '<strong>Remission<\/strong> is defined as trace or nil proteinuria (<1+) on dipstick on 3 consecutive early-morning samples. <strong>Relapse<\/strong> is ≥2+ proteinuria on 3 consecutive days. <strong>Frequently relapsing nephrotic syndrome (FRNS)<\/strong> requires ≥2 relapses within 6 months of the initial response, or ≥4 relapses in any 12-month period. <strong>Steroid-dependent NS (SDNS)<\/strong> means relapse during steroid taper or within 2 weeks of stopping. This child has had 2 relapses in 10 months, both >4 weeks after stopping — he is an <strong>infrequent relapser<\/strong> and retreatment with standard prednisolone suffices.',\n imgId: null\n },\n\n \/* \u2500\u2500 Question 4 \u2500\u2500 *\/\n {\n id: 4,\n tag: 'Complications — Infection',\n stem: 'A <strong>5-year-old boy<\/strong> with active nephrotic syndrome (serum albumin 1.4 g\/dL, gross ascites, generalised oedema) develops <strong>fever 39.2 \u00b0C and diffuse abdominal pain<\/strong> with guarding. Ascitic fluid aspiration shows a white cell count of <strong>500 cells\/mm³<\/strong> with 92% polymorphonuclear cells. Blood and ascitic fluid cultures are pending. Which organism is MOST LIKELY responsible, and why is this child at particular risk?',\n correct: '<em>Streptococcus pneumoniae<\/em> — due to urinary loss of IgG and opsonins impairing encapsulated-organism clearance',\n opts: [\n '<em>Streptococcus pneumoniae<\/em> — due to urinary loss of IgG and opsonins impairing encapsulated-organism clearance',\n '<em>Staphylococcus aureus<\/em> — due to breach of skin integrity from needle punctures and oedematous skin',\n '<em>Escherichia coli<\/em> — due to gut translocation across an oedematous bowel wall',\n '<em>Streptococcus pyogenes<\/em> — due to complement C3 deficiency causing failure of the alternative pathway'\n ],\n exp: '<strong>Spontaneous bacterial peritonitis (SBP)<\/strong> is the most dangerous infectious complication of nephrotic syndrome and is caused by <em>S. pneumoniae<\/em> in approximately two-thirds of cases. Nephrotic syndrome causes urinary loss of <strong>IgG, properdin, and factor B<\/strong> of the alternative complement pathway, severely impairing opsonisation of encapsulated bacteria such as pneumococcus. An ascitic PMN count ≥250 cells\/mm³ is diagnostic of SBP. Children with nephrotic syndrome should receive <strong>pneumococcal vaccination<\/strong> (PCV13 and PPSV23) and daily penicillin prophylaxis is sometimes used during relapse. Empirical antibiotic cover must include pneumococcal activity (e.g., cefotaxime).',\n imgId: null\n },\n\n \/* \u2500\u2500 Question 5 \u2500\u2500 *\/\n {\n id: 5,\n tag: 'Steroid Resistance — Management',\n stem: 'An <strong>8-year-old girl<\/strong> with presumed nephrotic syndrome has received oral prednisolone at 60 mg\/m²\/day for <strong>8 weeks<\/strong> without achieving remission. She also has <strong>persistent microscopic haematuria<\/strong>, her serum C3 is <strong>low<\/strong>, and blood pressure is elevated at <em>126\/84 mmHg<\/em> (above 95th centile for age and height). What is the MOST APPROPRIATE immediate next step?',\n correct: 'Renal biopsy to establish histological diagnosis before escalating immunosuppression',\n opts: [\n 'Renal biopsy to establish histological diagnosis before escalating immunosuppression',\n 'Empirically add cyclophosphamide to ongoing prednisolone without biopsy',\n 'Increase prednisolone dose to 80 mg\/m²\/day for a further 4 weeks',\n 'Start IV albumin 1 g\/kg and furosemide to mobilise oedema before any further workup'\n ],\n exp: '<strong>Steroid-resistant nephrotic syndrome (SRNS)<\/strong> is defined as failure to achieve remission after 4–8 weeks of full-dose prednisolone. <strong>Renal biopsy is mandatory<\/strong> in SRNS to guide therapy. Additional red flags in this child — haematuria, <em>low C3<\/em>, and hypertension — suggest a secondary or proliferative lesion such as <strong>FSGS, MPGN, or lupus nephritis<\/strong> rather than MCD. Biopsy findings direct specific therapy: calcineurin inhibitors (cyclosporine, tacrolimus) for FSGS; mycophenolate and steroids for lupus nephritis. Empirical escalation without histology risks administering the wrong immunosuppressive regimen and delaying the correct diagnosis.',\n imgId: null\n }\n\n ];\n \/* \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n END OF QUESTION BANK \u2014 do not edit below this line\n \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 *\/\n\n\n \/* \u2500\u2500 Internal state \u2014 nothing to edit \u2500\u2500 *\/\n var answers = {};\n var answered = 0;\n var shuffled = {};\n var done = false;\n\n \/* \u2500\u2500 DOM helpers \u2500\u2500 *\/\n function byId(id) { return document.getElementById(id); }\n function gid(suffix) { return byId(NS + '-' + suffix); }\n\n \/* \u2500\u2500 Fisher-Yates shuffle (pure ES5) \u2500\u2500 *\/\n function shuffleArr(arr) {\n var a = arr.slice(), i, j, tmp;\n for (i = a.length - 1; i > 0; i--) {\n j = Math.floor(Math.random() * (i + 1));\n tmp = a[i]; a[i] = a[j]; a[j] = tmp;\n }\n return a;\n }\n\n \/* \u2500\u2500 Count answers of a given value ('c' or 'w') \u2500\u2500 *\/\n function countVal(val) {\n var k, n = 0;\n for (k in answers) {\n if (answers.hasOwnProperty(k) && answers[k] === val) n++;\n }\n return n;\n }\n\n \/* \u2500\u2500 Build the five progress pips \u2500\u2500 *\/\n function buildPips() {\n var cont = gid('pips'), i, q, wLine, wPip, line, pip;\n cont.innerHTML = '';\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n \/* connecting line between pips (not before the first) *\/\n if (i > 0) {\n wLine = document.createElement('div');\n wLine.className = 'mr-pip-wrap';\n line = document.createElement('div');\n line.className = 'mr-pip-line';\n line.id = NS + '-pl' + q.id;\n wLine.appendChild(line);\n cont.appendChild(wLine);\n }\n \/* pip circle *\/\n wPip = document.createElement('div');\n wPip.className = 'mr-pip-wrap';\n pip = document.createElement('div');\n pip.className = 'mr-pip';\n pip.id = NS + '-pip' + q.id;\n pip.textContent = String(q.id);\n wPip.appendChild(pip);\n cont.appendChild(wPip);\n }\n }\n\n \/* \u2500\u2500 Build all case cards from the QS array \u2500\u2500 *\/\n function build() {\n var cont, i, q, opts, card, top, numDiv, meta, tag, stem,\n rule, optsDiv, expDiv, lbl, txt, imgDiv, imgSrc, j,\n optEl, ltrSpan, txtSpan;\n\n cont = gid('cases');\n cont.innerHTML = '';\n\n \/* reset state *\/\n answers = {}; answered = 0; shuffled = {}; done = false;\n gid('score').style.display = 'none';\n buildPips();\n\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n opts = shuffleArr(q.opts); \/* shuffle options fresh each load *\/\n shuffled[q.id] = opts; \/* store shuffled order for later use *\/\n\n \/* \u2500\u2500 outer card \u2500\u2500 *\/\n card = document.createElement('div');\n card.className = 'mr-case';\n\n \/* \u2500\u2500 top section: big number + tag + stem \u2500\u2500 *\/\n top = document.createElement('div');\n top.className = 'mr-case-top';\n\n numDiv = document.createElement('div');\n numDiv.className = 'mr-num';\n numDiv.textContent = q.id < 10 ? '0' + q.id : String(q.id);\n\n meta = document.createElement('div');\n meta.className = 'mr-meta';\n\n tag = document.createElement('div');\n tag.className = 'mr-tag';\n tag.innerHTML = q.tag; \/* innerHTML so — etc. render *\/\n\n stem = document.createElement('div');\n stem.className = 'mr-stem';\n stem.innerHTML = q.stem;\n\n meta.appendChild(tag);\n meta.appendChild(stem);\n top.appendChild(numDiv);\n top.appendChild(meta);\n card.appendChild(top);\n\n \/* \u2500\u2500 divider line \u2500\u2500 *\/\n rule = document.createElement('div');\n rule.className = 'mr-rule';\n card.appendChild(rule);\n\n \/* \u2500\u2500 answer options \u2500\u2500 *\/\n optsDiv = document.createElement('div');\n optsDiv.className = 'mr-opts';\n\n for (j = 0; j < opts.length; j++) {\n optEl = document.createElement('div');\n optEl.className = 'mr-opt';\n optEl.id = NS + '-o' + q.id + '-' + j;\n optEl.setAttribute('role', 'button');\n optEl.setAttribute('tabindex', '0');\n\n ltrSpan = document.createElement('span');\n ltrSpan.className = 'mr-ltr';\n ltrSpan.textContent = LTRS[j];\n\n txtSpan = document.createElement('span');\n txtSpan.className = 'mr-opt-text';\n txtSpan.innerHTML = opts[j];\n\n optEl.appendChild(ltrSpan);\n optEl.appendChild(txtSpan);\n optsDiv.appendChild(optEl);\n\n \/* IIFE to capture correct qid and oi for each click listener *\/\n (function (qid, oi) {\n optEl.addEventListener('click', function () { pick(qid, oi); });\n }(q.id, j));\n }\n card.appendChild(optsDiv);\n\n \/* \u2500\u2500 explanation (hidden until the user answers) \u2500\u2500 *\/\n expDiv = document.createElement('div');\n expDiv.className = 'mr-exp';\n expDiv.id = NS + '-exp' + q.id;\n\n lbl = document.createElement('div');\n lbl.className = 'mr-exp-lbl';\n lbl.textContent = 'Debrief';\n\n txt = document.createElement('div');\n txt.className = 'mr-exp-text';\n txt.innerHTML = q.exp;\n\n expDiv.appendChild(lbl);\n expDiv.appendChild(txt);\n\n \/* inject image if this question has one *\/\n if (q.imgId) {\n imgSrc = byId(q.imgId);\n if (imgSrc) {\n imgDiv = document.createElement('div');\n imgDiv.innerHTML = imgSrc.innerHTML; \/* clone HTML from hidden div *\/\n expDiv.appendChild(imgDiv);\n }\n }\n\n card.appendChild(expDiv);\n cont.appendChild(card);\n }\n }\n\n \/* \u2500\u2500 Handle a user clicking an option \u2500\u2500 *\/\n function pick(qid, oi) {\n var q, opts, i, el, correct;\n\n if (answers[qid] !== undefined || done) return; \/* ignore if already answered *\/\n\n \/* find the question object *\/\n q = null;\n for (i = 0; i < QS.length; i++) {\n if (QS[i].id === qid) { q = QS[i]; break; }\n }\n if (!q) return;\n\n opts = shuffled[qid];\n correct = (opts[oi] === q.correct); \/* string comparison *\/\n answers[qid] = correct ? 'c' : 'w';\n answered++;\n\n \/* style all four options *\/\n for (i = 0; i < opts.length; i++) {\n el = byId(NS + '-o' + qid + '-' + i);\n if (opts[i] === q.correct) {\n el.className = 'mr-opt correct locked';\n } else if (i === oi) {\n el.className = 'mr-opt wrong locked';\n } else {\n el.className = 'mr-opt dimmed locked';\n }\n }\n\n \/* reveal explanation *\/\n byId(NS + '-exp' + qid).style.display = 'block';\n\n \/* colour the progress pip *\/\n byId(NS + '-pip' + qid).className = 'mr-pip ' + (correct ? 'correct' : 'wrong');\n\n \/* colour the connecting line that leads TO this pip *\/\n if (qid > 1) {\n var pl = gid('pl' + qid);\n if (pl) pl.className = 'mr-pip-line done';\n }\n }\n\n \/* \u2500\u2500 Show the score panel after Submit is clicked \u2500\u2500 *\/\n function showScore() {\n var c, w, s, net, pct, disp, verdicts, vi, sc;\n if (done) return;\n done = true;\n\n c = countVal('c');\n w = countVal('w');\n s = TOTAL - answered;\n net = (c * 4) - w;\n pct = Math.max(0, Math.round((net \/ MAX) * 100));\n disp = Math.min(100, Math.max(0, pct));\n\n \/* fill the donut ring \u2014 colour matches --ter (teal-blue) *\/\n gid('ring').style.background =\n 'conic-gradient(#2A6E8A ' + disp + '%, #D8E8EE 0%)';\n\n gid('pct').textContent = pct + '%';\n gid('net').textContent = 'Net Score: ' + net + ' \/ ' + MAX;\n\n \/* pick verdict by correct count *\/\n verdicts = [\n [5, 'Perfect round. Exceptional clinical reasoning.'],\n [4, 'Strong \\u2014 one nuance to revisit.'],\n [3, 'Solid base \\u2014 consolidate the finer distinctions.'],\n [2, 'Halfway there \\u2014 review the missed cases carefully.'],\n [0, 'These cases repay close reading. Come back tomorrow.']\n ];\n gid('verdict').textContent = verdicts[4][1]; \/* default: lowest *\/\n for (vi = 0; vi < verdicts.length; vi++) {\n if (c >= verdicts[vi][0]) {\n gid('verdict').textContent = verdicts[vi][1];\n break;\n }\n }\n\n \/* unicode escapes so no multi-byte literals in source *\/\n gid('ct-c').textContent = '\\u2705 ' + c + ' Correct';\n gid('ct-w').textContent = '\\u274C ' + w + ' Wrong';\n gid('ct-s').textContent = '\\u23ED ' + s + ' Skipped';\n\n sc = gid('score');\n sc.style.display = 'block';\n sc.scrollIntoView({ behavior: 'smooth', block: 'center' });\n }\n\n \/* \u2500\u2500 Sticky progress bar via IntersectionObserver \u2500\u2500\n When the sentinel div (just below the header) leaves the\n viewport, the fixed progress bar appears. When the sentinel\n comes back into view (user scrolled back up), bar disappears. *\/\n function initObserver() {\n var sentinel = gid('sentinel'), bar = gid('progress');\n if (!sentinel || !bar || !window.IntersectionObserver) return;\n new IntersectionObserver(function (entries) {\n if (!entries[0].isIntersecting) {\n bar.className = 'mr-progress visible';\n } else {\n bar.className = 'mr-progress';\n }\n }, { threshold: 0 }).observe(sentinel);\n }\n\n \/* \u2500\u2500 Bootstrap \u2500\u2500 *\/\n function init() {\n gid('submit').addEventListener('click', showScore);\n gid('retry').addEventListener('click', function () {\n build();\n window.scrollTo(0, 0);\n });\n initObserver();\n build();\n }\n\n if (document.readyState === 'loading') {\n document.addEventListener('DOMContentLoaded', init);\n } else {\n init();\n }\n\n}());\n<\/script>\n<\/body>\n<\/html>\n\n\n","protected":false},"excerpt":{"rendered":"<p>NORMAL MINIMAL CHANGE DISEASE GBM fenestrated endothelium podocyte cell body foot processes interdigitated slit diaphragm intact Normal filtration barrier GBM (normal on LM) fenestrated endothelium podocyte cell body slit diaphragm lost foot processes fused \/ effaced seen only on EM \u2014 LM is normal ↑ protein leak → nephrotic syndrome Electron-microscopy schematic. Normal: podocyte foot… <\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[24],"tags":[],"class_list":["post-36707","post","type-post","status-publish","format-standard","hentry","category-neet-pg"],"yoast_head":"\n<title>Paediatric Nephrotic Syndrome - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/04\/27\/paediatric-nephrotic-syndrome\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Paediatric Nephrotic Syndrome - atsixty\" \/>\n<meta property=\"og:description\" content=\"NORMAL MINIMAL CHANGE DISEASE GBM fenestrated endothelium podocyte cell body foot processes interdigitated slit diaphragm intact Normal filtration barrier GBM (normal on LM) fenestrated endothelium podocyte cell body slit diaphragm lost foot processes fused \/ effaced seen only on EM \u2014 LM is normal ↑ protein leak → nephrotic syndrome Electron-microscopy schematic. 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xmlns=\"http:\/\/www.w3.org\/2000\/svg\" style=\"width:100%;max-width:560px;display:block;margin:0 auto\">\n\n \n <rect x=\"0\" y=\"0\" width=\"270\" height=\"220\" rx=\"8\" fill=\"#f0f6fa\"\/>\n <rect x=\"290\" y=\"0\" width=\"270\" height=\"220\" rx=\"8\" fill=\"#f0f6fa\"\/>\n\n \n <text x=\"135\" y=\"18\" text-anchor=\"middle\" fill=\"#4A7A9A\" font-size=\"10\" font-family=\"Georgia,serif\" font-weight=\"bold\">NORMAL<\/text>\n <text x=\"425\" y=\"18\" text-anchor=\"middle\" fill=\"#4A7A9A\" font-size=\"10\" font-family=\"Georgia,serif\" font-weight=\"bold\">MINIMAL CHANGE DISEASE<\/text>\n\n \n\n \n <rect x=\"15\" y=\"90\" width=\"240\" height=\"18\" rx=\"3\" fill=\"#C5D8E8\" opacity=\"0.8\"\/>\n <text x=\"135\" y=\"101\" text-anchor=\"middle\" fill=\"#2A5A7A\" font-size=\"8\" font-family=\"Georgia,serif\">GBM<\/text>\n\n \n <rect x=\"15\" y=\"108\" width=\"240\" height=\"14\" rx=\"2\" fill=\"#A8C8E0\" opacity=\"0.5\"\/>\n <text x=\"135\" y=\"118\" text-anchor=\"middle\" fill=\"#2A5A7A\" font-size=\"7.5\" font-family=\"Georgia,serif\" font-style=\"italic\">fenestrated endothelium<\/text>\n\n \n <ellipse cx=\"135\" cy=\"62\" rx=\"52\" ry=\"18\" fill=\"#B8D8F0\" opacity=\"0.7\"\/>\n <text x=\"135\" y=\"65\" text-anchor=\"middle\" fill=\"#1A4A6A\" font-size=\"8\" font-family=\"Georgia,serif\">podocyte cell body<\/text>\n\n \n \n <rect x=\"32\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"52\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"72\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"92\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"112\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"132\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"152\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"172\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"192\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n \n <rect x=\"212\" y=\"68\" width=\"12\" height=\"22\" rx=\"4\" fill=\"#7AB8D8\"\/>\n\n \n <line x1=\"44\" y1=\"80\" x2=\"52\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"64\" y1=\"80\" x2=\"72\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"84\" y1=\"80\" x2=\"92\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"104\" y1=\"80\" x2=\"112\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"124\" y1=\"80\" x2=\"132\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"144\" y1=\"80\" x2=\"152\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"164\" y1=\"80\" x2=\"172\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"184\" y1=\"80\" x2=\"192\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n <line x1=\"204\" y1=\"80\" x2=\"212\" y2=\"80\" stroke=\"#2A7AAA\" stroke-width=\"2\" stroke-linecap=\"round\"\/>\n\n \n <text x=\"135\" y=\"155\" text-anchor=\"middle\" fill=\"#3A7A9A\" font-size=\"8\" font-family=\"Georgia,serif\">foot processes interdigitated<\/text>\n <text x=\"135\" y=\"166\" text-anchor=\"middle\" fill=\"#3A7A9A\" font-size=\"8\" font-family=\"Georgia,serif\">slit diaphragm intact<\/text>\n <text x=\"135\" y=\"180\" text-anchor=\"middle\" fill=\"#2D6B47\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">Normal filtration barrier<\/text>\n\n \n\n \n <rect x=\"305\" y=\"90\" width=\"240\" height=\"18\" rx=\"3\" fill=\"#C5D8E8\" opacity=\"0.8\"\/>\n <text x=\"425\" y=\"101\" text-anchor=\"middle\" fill=\"#2A5A7A\" font-size=\"8\" font-family=\"Georgia,serif\">GBM (normal on LM)<\/text>\n\n \n <rect x=\"305\" y=\"108\" width=\"240\" height=\"14\" rx=\"2\" fill=\"#A8C8E0\" opacity=\"0.5\"\/>\n <text x=\"425\" y=\"118\" text-anchor=\"middle\" fill=\"#2A5A7A\" font-size=\"7.5\" font-family=\"Georgia,serif\" font-style=\"italic\">fenestrated endothelium<\/text>\n\n \n <ellipse cx=\"425\" cy=\"62\" rx=\"52\" ry=\"18\" fill=\"#B8D8F0\" opacity=\"0.7\"\/>\n <text x=\"425\" y=\"65\" text-anchor=\"middle\" fill=\"#1A4A6A\" font-size=\"8\" font-family=\"Georgia,serif\">podocyte cell body<\/text>\n\n \n <rect x=\"322\" y=\"68\" width=\"244\" height=\"22\" rx=\"5\" fill=\"#7AB8D8\" opacity=\"0.85\"\/>\n\n \n <line x1=\"368\" y1=\"73\" x2=\"488\" y2=\"85\" stroke=\"#B83232\" stroke-width=\"1.8\" stroke-dasharray=\"4,3\" opacity=\"0.7\"\/>\n <text x=\"427\" y=\"80\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"7.5\" font-family=\"Georgia,serif\" font-style=\"italic\">slit diaphragm lost<\/text>\n\n \n <text x=\"425\" y=\"155\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"8\" font-family=\"Georgia,serif\">foot processes fused \/ effaced<\/text>\n <text x=\"425\" y=\"166\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"8\" font-family=\"Georgia,serif\">seen only on EM \u2014 LM is normal<\/text>\n <text x=\"425\" y=\"180\" text-anchor=\"middle\" fill=\"#B83232\" font-size=\"8.5\" font-family=\"Georgia,serif\" font-weight=\"bold\">↑ protein leak → nephrotic syndrome<\/text>\n\n <\/svg>\n <figcaption>\n Electron-microscopy schematic. <strong>Normal<\/strong>: podocyte foot processes interdigitate with\n slit diaphragms intact \u2014 the primary barrier to protein. <strong>MCD<\/strong>: diffuse foot-process\n effacement obliterates the slit diaphragm; light microscopy and immunofluorescence remain\n <em>normal<\/em> \u2014 EM is the defining investigation.\n <\/figcaption>\n <\/figure>\n<\/div>\n\n\n\n<div id=\"mrq01\">\n\n \n <div class=\"mr-header\">\n <div class=\"mr-eyebrow\">Morning Rounds · Daily Clinical Quiz<\/div>\n <div class=\"mr-title\">\n Paediatric Nephrotic Syndrome<br><em>Clinical Reasoning<\/em>\n <\/div>\n <div class=\"mr-subtitle\">Five cases · Read carefully · Trust your instinct<\/div>\n <div class=\"mr-chips\">\n <span class=\"mr-chip\">5 Cases<\/span>\n <span class=\"mr-chip\">+4 \/ −1 scoring<\/span>\n <span class=\"mr-chip\">Options reshuffled<\/span>\n <\/div>\n <\/div>\n\n \n <div class=\"mr-sentinel\" id=\"mrq01-sentinel\"><\/div>\n\n \n <div class=\"mr-progress\" id=\"mrq01-progress\">\n <div class=\"mr-prog-inner\">\n <div class=\"mr-pips\" id=\"mrq01-pips\"><\/div>\n <\/div>\n <\/div>\n\n <div class=\"mr-body\">\n\n \n <div id=\"mrq01-cases\"><\/div>\n\n <div class=\"mr-submit-wrap\">\n <button class=\"mr-btn\" id=\"mrq01-submit\">Submit for Debrief<\/button>\n <\/div>\n\n \n <div class=\"mr-score\" id=\"mrq01-score\">\n <div class=\"mr-score-in\">\n <div class=\"mr-score-ey\">Round Complete<\/div>\n <div class=\"mr-ring\" id=\"mrq01-ring\">\n <div class=\"mr-ring-in\">\n <span class=\"mr-ring-pct\" id=\"mrq01-pct\">0%<\/span>\n <span class=\"mr-ring-sub\">net<\/span>\n <\/div>\n <\/div>\n <div class=\"mr-score-title\">Your Debrief<\/div>\n <div class=\"mr-score-net\" id=\"mrq01-net\"><\/div>\n <div class=\"mr-verdict\" id=\"mrq01-verdict\"><\/div>\n <div class=\"mr-bands\">\n <span class=\"mr-band mr-band-c\" id=\"mrq01-ct-c\"><\/span>\n <span class=\"mr-band mr-band-w\" id=\"mrq01-ct-w\"><\/span>\n <span class=\"mr-band mr-band-s\" id=\"mrq01-ct-s\"><\/span>\n <\/div>\n <button class=\"mr-retry\" id=\"mrq01-retry\">↻ New Round<\/button>\n <\/div>\n <\/div>\n\n <\/div>\n<\/div>\n\n\n<script>\n(function () {\n 'use strict';\n\n \/* \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n NAMESPACE \u2014 one string that prefixes every element id.\n If you ever put two quizzes on the same page, change\n 'mrq01' to 'mrq02' in one of them (and update every\n id=\"mrq01-...\" in the HTML above to match).\n \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 *\/\n var NS = 'mrq01';\n var TOTAL = 5;\n var MAX = 20; \/* TOTAL \u00d7 4 \u2014 update if you ever change TOTAL *\/\n var LTRS = ['A','B','C','D'];\n\n\n \/* \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n \u2605 EDIT HERE \u2605 \u2014 THE QUESTION BANK\n \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n\n QS is an array of 5 question objects.\n Each object has these fields:\n\n id \u2014 question number 1\u20135. Keep in order. Don't skip.\n\n tag \u2014 short topic label shown above the stem in small caps.\n\n stem \u2014 the question text. HTML tags allowed inside the string.\n\n correct \u2014 EXACT text of the correct option.\n Must match one of the entries in opts, character for character.\n\n opts \u2014 array of exactly 4 answer strings (shuffled on every load).\n\n exp \u2014 explanation shown after the user answers (3\u20135 sentences).\n\n imgId \u2014 'mrq01-img1' to show the image; null to show nothing.\n Only set on ONE question.\n\n \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 *\/\n var QS = [\n\n \/* \u2500\u2500 Question 1 \u2500\u2500 *\/\n {\n id: 1,\n tag: 'Histopathology — Diagnosis',\n stem: 'A <strong>4-year-old boy<\/strong> presents with periorbital puffiness for one week, worse on waking, and progressive bilateral leg oedema. Urine dipstick shows <strong>3+ protein<\/strong> with no blood. Serum albumin is <strong>1.7 g\/dL<\/strong>, cholesterol is elevated, and complement C3 is normal. Light microscopy of a renal biopsy shows <em>no abnormality<\/em>; immunofluorescence is negative. Which underlying ultrastructural finding on electron microscopy confirms the diagnosis?',\n correct: 'Diffuse effacement of podocyte foot processes with loss of the slit diaphragm',\n opts: [\n 'Diffuse effacement of podocyte foot processes with loss of the slit diaphragm',\n 'Segmental sclerosis and hyalinosis affecting a proportion of glomeruli',\n 'Subepithelial electron-dense deposits producing a spike-and-dome pattern',\n 'Mesangial and subendothelial immune complex deposits with GBM duplication'\n ],\n exp: '<strong>Minimal Change Disease (MCD)<\/strong> accounts for approximately 90% of nephrotic syndrome in children aged 1–8 years. Light microscopy and immunofluorescence are characteristically <em>normal<\/em>; the diagnostic lesion is <strong>diffuse podocyte foot-process effacement<\/strong> seen only on electron microscopy. This disrupts the slit diaphragm, abolishing the charge and size barrier to albumin. C3 is normal (unlike MPGN or lupus nephritis). MCD is exquisitely steroid-sensitive: over 90% of children achieve remission with prednisolone.',\n imgId: 'mrq01-img1'\n },\n\n \/* \u2500\u2500 Question 2 \u2500\u2500 *\/\n {\n id: 2,\n tag: 'Treatment — First Episode',\n stem: 'A <strong>5-year-old girl<\/strong> presents with her first episode of nephrotic syndrome. There is no haematuria, blood pressure is normal for age, serum C3 is normal, and there are no clinical features to suggest a secondary cause. She has no contraindications to steroids. According to <strong>ISKDC guidelines<\/strong>, what is the recommended first-line regimen?',\n correct: 'Oral prednisolone 60 mg\/m²\/day (max 60 mg) for 4 weeks, then 40 mg\/m² on alternate days for 4 weeks',\n opts: [\n 'Oral prednisolone 60 mg\/m²\/day (max 60 mg) for 4 weeks, then 40 mg\/m² on alternate days for 4 weeks',\n 'IV methylprednisolone pulses 1 g\/1.73 m² for 3 days followed by oral prednisolone',\n 'Oral cyclophosphamide 2–3 mg\/kg\/day for 12 weeks as initial therapy',\n 'Cyclosporine 4–5 mg\/kg\/day in two divided doses with trough monitoring'\n ],\n exp: 'The <strong>ISKDC protocol<\/strong> for a first episode of childhood nephrotic syndrome is <strong>oral prednisolone 60 mg\/m²\/day<\/strong> (maximum 60 mg) for 4 weeks, followed by <strong>40 mg\/m²<\/strong> on alternate days for a further 4 weeks. A favourable response to steroids effectively confirms MCD without the need for a biopsy. IV methylprednisolone, cyclophosphamide, and cyclosporine are reserved for steroid resistance, frequent relapsers, or steroid-dependent disease. Renal biopsy at first presentation is not routinely indicated in a school-age child with a typical clinical picture.',\n imgId: null\n },\n\n \/* \u2500\u2500 Question 3 \u2500\u2500 *\/\n {\n id: 3,\n tag: 'Relapse — Classification',\n stem: 'A <strong>6-year-old boy<\/strong> achieved remission after his first episode of nephrotic syndrome with standard steroid therapy. He was off steroids for 3 months when his mother noticed facial puffiness returning. Urine dipstick shows <strong>3+ protein on three consecutive mornings<\/strong>. Over the past 10 months he has had <em>two relapses including this one<\/em>, both occurring more than 4 weeks after stopping steroids. How is this episode best classified, and what is the appropriate next step?',\n correct: 'Infrequent relapser — treat with prednisolone 60 mg\/m²\/day until remission, then taper',\n opts: [\n 'Infrequent relapser — treat with prednisolone 60 mg\/m²\/day until remission, then taper',\n 'Frequently relapsing nephrotic syndrome — add levamisole or low-dose alternate-day steroids',\n 'Steroid-dependent nephrotic syndrome — start cyclosporine immediately',\n 'Steroid-resistant nephrotic syndrome — perform renal biopsy before retreating'\n ],\n exp: '<strong>Remission<\/strong> is defined as trace or nil proteinuria (<1+) on dipstick on 3 consecutive early-morning samples. <strong>Relapse<\/strong> is ≥2+ proteinuria on 3 consecutive days. <strong>Frequently relapsing nephrotic syndrome (FRNS)<\/strong> requires ≥2 relapses within 6 months of the initial response, or ≥4 relapses in any 12-month period. <strong>Steroid-dependent NS (SDNS)<\/strong> means relapse during steroid taper or within 2 weeks of stopping. This child has had 2 relapses in 10 months, both >4 weeks after stopping — he is an <strong>infrequent relapser<\/strong> and retreatment with standard prednisolone suffices.',\n imgId: null\n },\n\n \/* \u2500\u2500 Question 4 \u2500\u2500 *\/\n {\n id: 4,\n tag: 'Complications — Infection',\n stem: 'A <strong>5-year-old boy<\/strong> with active nephrotic syndrome (serum albumin 1.4 g\/dL, gross ascites, generalised oedema) develops <strong>fever 39.2 \u00b0C and diffuse abdominal pain<\/strong> with guarding. Ascitic fluid aspiration shows a white cell count of <strong>500 cells\/mm³<\/strong> with 92% polymorphonuclear cells. Blood and ascitic fluid cultures are pending. Which organism is MOST LIKELY responsible, and why is this child at particular risk?',\n correct: '<em>Streptococcus pneumoniae<\/em> — due to urinary loss of IgG and opsonins impairing encapsulated-organism clearance',\n opts: [\n '<em>Streptococcus pneumoniae<\/em> — due to urinary loss of IgG and opsonins impairing encapsulated-organism clearance',\n '<em>Staphylococcus aureus<\/em> — due to breach of skin integrity from needle punctures and oedematous skin',\n '<em>Escherichia coli<\/em> — due to gut translocation across an oedematous bowel wall',\n '<em>Streptococcus pyogenes<\/em> — due to complement C3 deficiency causing failure of the alternative pathway'\n ],\n exp: '<strong>Spontaneous bacterial peritonitis (SBP)<\/strong> is the most dangerous infectious complication of nephrotic syndrome and is caused by <em>S. pneumoniae<\/em> in approximately two-thirds of cases. Nephrotic syndrome causes urinary loss of <strong>IgG, properdin, and factor B<\/strong> of the alternative complement pathway, severely impairing opsonisation of encapsulated bacteria such as pneumococcus. An ascitic PMN count ≥250 cells\/mm³ is diagnostic of SBP. Children with nephrotic syndrome should receive <strong>pneumococcal vaccination<\/strong> (PCV13 and PPSV23) and daily penicillin prophylaxis is sometimes used during relapse. Empirical antibiotic cover must include pneumococcal activity (e.g., cefotaxime).',\n imgId: null\n },\n\n \/* \u2500\u2500 Question 5 \u2500\u2500 *\/\n {\n id: 5,\n tag: 'Steroid Resistance — Management',\n stem: 'An <strong>8-year-old girl<\/strong> with presumed nephrotic syndrome has received oral prednisolone at 60 mg\/m²\/day for <strong>8 weeks<\/strong> without achieving remission. She also has <strong>persistent microscopic haematuria<\/strong>, her serum C3 is <strong>low<\/strong>, and blood pressure is elevated at <em>126\/84 mmHg<\/em> (above 95th centile for age and height). What is the MOST APPROPRIATE immediate next step?',\n correct: 'Renal biopsy to establish histological diagnosis before escalating immunosuppression',\n opts: [\n 'Renal biopsy to establish histological diagnosis before escalating immunosuppression',\n 'Empirically add cyclophosphamide to ongoing prednisolone without biopsy',\n 'Increase prednisolone dose to 80 mg\/m²\/day for a further 4 weeks',\n 'Start IV albumin 1 g\/kg and furosemide to mobilise oedema before any further workup'\n ],\n exp: '<strong>Steroid-resistant nephrotic syndrome (SRNS)<\/strong> is defined as failure to achieve remission after 4–8 weeks of full-dose prednisolone. <strong>Renal biopsy is mandatory<\/strong> in SRNS to guide therapy. Additional red flags in this child — haematuria, <em>low C3<\/em>, and hypertension — suggest a secondary or proliferative lesion such as <strong>FSGS, MPGN, or lupus nephritis<\/strong> rather than MCD. Biopsy findings direct specific therapy: calcineurin inhibitors (cyclosporine, tacrolimus) for FSGS; mycophenolate and steroids for lupus nephritis. Empirical escalation without histology risks administering the wrong immunosuppressive regimen and delaying the correct diagnosis.',\n imgId: null\n }\n\n ];\n \/* \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\n END OF QUESTION BANK \u2014 do not edit below this line\n \u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550\u2550 *\/\n\n\n \/* \u2500\u2500 Internal state \u2014 nothing to edit \u2500\u2500 *\/\n var answers = {};\n var answered = 0;\n var shuffled = {};\n var done = false;\n\n \/* \u2500\u2500 DOM helpers \u2500\u2500 *\/\n function byId(id) { return document.getElementById(id); }\n function gid(suffix) { return byId(NS + '-' + suffix); }\n\n \/* \u2500\u2500 Fisher-Yates shuffle (pure ES5) \u2500\u2500 *\/\n function shuffleArr(arr) {\n var a = arr.slice(), i, j, tmp;\n for (i = a.length - 1; i > 0; i--) {\n j = Math.floor(Math.random() * (i + 1));\n tmp = a[i]; a[i] = a[j]; a[j] = tmp;\n }\n return a;\n }\n\n \/* \u2500\u2500 Count answers of a given value ('c' or 'w') \u2500\u2500 *\/\n function countVal(val) {\n var k, n = 0;\n for (k in answers) {\n if (answers.hasOwnProperty(k) && answers[k] === val) n++;\n }\n return n;\n }\n\n \/* \u2500\u2500 Build the five progress pips \u2500\u2500 *\/\n function buildPips() {\n var cont = gid('pips'), i, q, wLine, wPip, line, pip;\n cont.innerHTML = '';\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n \/* connecting line between pips (not before the first) *\/\n if (i > 0) {\n wLine = document.createElement('div');\n wLine.className = 'mr-pip-wrap';\n line = document.createElement('div');\n line.className = 'mr-pip-line';\n line.id = NS + '-pl' + q.id;\n wLine.appendChild(line);\n cont.appendChild(wLine);\n }\n \/* pip circle *\/\n wPip = document.createElement('div');\n wPip.className = 'mr-pip-wrap';\n pip = document.createElement('div');\n pip.className = 'mr-pip';\n pip.id = NS + '-pip' + q.id;\n pip.textContent = String(q.id);\n wPip.appendChild(pip);\n cont.appendChild(wPip);\n }\n }\n\n \/* \u2500\u2500 Build all case cards from the QS array \u2500\u2500 *\/\n function build() {\n var cont, i, q, opts, card, top, numDiv, meta, tag, stem,\n rule, optsDiv, expDiv, lbl, txt, imgDiv, imgSrc, j,\n optEl, ltrSpan, txtSpan;\n\n cont = gid('cases');\n cont.innerHTML = '';\n\n \/* reset state *\/\n answers = {}; answered = 0; shuffled = {}; done = false;\n gid('score').style.display = 'none';\n buildPips();\n\n for (i = 0; i < QS.length; i++) {\n q = QS[i];\n opts = shuffleArr(q.opts); \/* shuffle options fresh each load *\/\n shuffled[q.id] = opts; \/* store shuffled order for later use *\/\n\n \/* \u2500\u2500 outer card \u2500\u2500 *\/\n card = document.createElement('div');\n card.className = 'mr-case';\n\n \/* \u2500\u2500 top section: big number + tag + stem \u2500\u2500 *\/\n top = document.createElement('div');\n top.className = 'mr-case-top';\n\n numDiv = document.createElement('div');\n numDiv.className = 'mr-num';\n numDiv.textContent = q.id < 10 ? '0' + q.id : String(q.id);\n\n meta = document.createElement('div');\n meta.className = 'mr-meta';\n\n tag = document.createElement('div');\n tag.className = 'mr-tag';\n tag.innerHTML = q.tag; \/* innerHTML so — etc. render *\/\n\n stem = document.createElement('div');\n stem.className = 'mr-stem';\n stem.innerHTML = q.stem;\n\n meta.appendChild(tag);\n meta.appendChild(stem);\n top.appendChild(numDiv);\n top.appendChild(meta);\n card.appendChild(top);\n\n \/* \u2500\u2500 divider line \u2500\u2500 *\/\n rule = document.createElement('div');\n rule.className = 'mr-rule';\n card.appendChild(rule);\n\n \/* \u2500\u2500 answer options \u2500\u2500 *\/\n optsDiv = document.createElement('div');\n optsDiv.className = 'mr-opts';\n\n for (j = 0; j < opts.length; j++) {\n optEl = document.createElement('div');\n optEl.className = 'mr-opt';\n optEl.id = NS + '-o' + q.id + '-' + j;\n optEl.setAttribute('role', 'button');\n optEl.setAttribute('tabindex', '0');\n\n ltrSpan = document.createElement('span');\n ltrSpan.className = 'mr-ltr';\n ltrSpan.textContent = LTRS[j];\n\n txtSpan = document.createElement('span');\n txtSpan.className = 'mr-opt-text';\n txtSpan.innerHTML = opts[j];\n\n optEl.appendChild(ltrSpan);\n optEl.appendChild(txtSpan);\n optsDiv.appendChild(optEl);\n\n \/* IIFE to capture correct qid and oi for each click listener *\/\n (function (qid, oi) {\n optEl.addEventListener('click', function () { pick(qid, oi); });\n }(q.id, j));\n }\n card.appendChild(optsDiv);\n\n \/* \u2500\u2500 explanation (hidden until the user answers) \u2500\u2500 *\/\n expDiv = document.createElement('div');\n expDiv.className = 'mr-exp';\n expDiv.id = NS + '-exp' + q.id;\n\n lbl = document.createElement('div');\n lbl.className = 'mr-exp-lbl';\n lbl.textContent = 'Debrief';\n\n txt = document.createElement('div');\n txt.className = 'mr-exp-text';\n txt.innerHTML = q.exp;\n\n expDiv.appendChild(lbl);\n expDiv.appendChild(txt);\n\n \/* inject image if this question has one *\/\n if (q.imgId) {\n imgSrc = byId(q.imgId);\n if (imgSrc) {\n imgDiv = document.createElement('div');\n imgDiv.innerHTML = imgSrc.innerHTML; \/* clone HTML from hidden div *\/\n expDiv.appendChild(imgDiv);\n }\n }\n\n card.appendChild(expDiv);\n cont.appendChild(card);\n }\n }\n\n \/* \u2500\u2500 Handle a user clicking an option \u2500\u2500 *\/\n function pick(qid, oi) {\n var q, opts, i, el, correct;\n\n if (answers[qid] !== undefined || done) return; \/* ignore if already answered *\/\n\n \/* find the question object *\/\n q = null;\n for (i = 0; i < QS.length; i++) {\n if (QS[i].id === qid) { q = QS[i]; break; }\n }\n if (!q) return;\n\n opts = shuffled[qid];\n correct = (opts[oi] === q.correct); \/* string comparison *\/\n answers[qid] = correct ? 'c' : 'w';\n answered++;\n\n \/* style all four options *\/\n for (i = 0; i < opts.length; i++) {\n el = byId(NS + '-o' + qid + '-' + i);\n if (opts[i] === q.correct) {\n el.className = 'mr-opt correct locked';\n } else if (i === oi) {\n el.className = 'mr-opt wrong locked';\n } else {\n el.className = 'mr-opt dimmed locked';\n }\n }\n\n \/* reveal explanation *\/\n byId(NS + '-exp' + qid).style.display = 'block';\n\n \/* colour the progress pip *\/\n byId(NS + '-pip' + qid).className = 'mr-pip ' + (correct ? 'correct' : 'wrong');\n\n \/* colour the connecting line that leads TO this pip *\/\n if (qid > 1) {\n var pl = gid('pl' + qid);\n if (pl) pl.className = 'mr-pip-line done';\n }\n }\n\n \/* \u2500\u2500 Show the score panel after Submit is clicked \u2500\u2500 *\/\n function showScore() {\n var c, w, s, net, pct, disp, verdicts, vi, sc;\n if (done) return;\n done = true;\n\n c = countVal('c');\n w = countVal('w');\n s = TOTAL - answered;\n net = (c * 4) - w;\n pct = Math.max(0, Math.round((net \/ MAX) * 100));\n disp = Math.min(100, Math.max(0, pct));\n\n \/* fill the donut ring \u2014 colour matches --ter (teal-blue) *\/\n gid('ring').style.background =\n 'conic-gradient(#2A6E8A ' + disp + '%, #D8E8EE 0%)';\n\n gid('pct').textContent = pct + '%';\n gid('net').textContent = 'Net Score: ' + net + ' \/ ' + MAX;\n\n \/* pick verdict by correct count *\/\n verdicts = [\n [5, 'Perfect round. Exceptional clinical reasoning.'],\n [4, 'Strong \\u2014 one nuance to revisit.'],\n [3, 'Solid base \\u2014 consolidate the finer distinctions.'],\n [2, 'Halfway there \\u2014 review the missed cases carefully.'],\n [0, 'These cases repay close reading. Come back tomorrow.']\n ];\n gid('verdict').textContent = verdicts[4][1]; \/* default: lowest *\/\n for (vi = 0; vi < verdicts.length; vi++) {\n if (c >= verdicts[vi][0]) {\n gid('verdict').textContent = verdicts[vi][1];\n break;\n }\n }\n\n \/* unicode escapes so no multi-byte literals in source *\/\n gid('ct-c').textContent = '\\u2705 ' + c + ' Correct';\n gid('ct-w').textContent = '\\u274C ' + w + ' Wrong';\n gid('ct-s').textContent = '\\u23ED ' + s + ' Skipped';\n\n sc = gid('score');\n sc.style.display = 'block';\n sc.scrollIntoView({ behavior: 'smooth', block: 'center' });\n }\n\n \/* \u2500\u2500 Sticky progress bar via IntersectionObserver \u2500\u2500\n When the sentinel div (just below the header) leaves the\n viewport, the fixed progress bar appears. When the sentinel\n comes back into view (user scrolled back up), bar disappears. *\/\n function initObserver() {\n var sentinel = gid('sentinel'), bar = gid('progress');\n if (!sentinel || !bar || !window.IntersectionObserver) return;\n new IntersectionObserver(function (entries) {\n if (!entries[0].isIntersecting) {\n bar.className = 'mr-progress visible';\n } else {\n bar.className = 'mr-progress';\n }\n }, { threshold: 0 }).observe(sentinel);\n }\n\n \/* \u2500\u2500 Bootstrap \u2500\u2500 *\/\n function init() {\n gid('submit').addEventListener('click', showScore);\n gid('retry').addEventListener('click', function () {\n build();\n window.scrollTo(0, 0);\n });\n initObserver();\n build();\n }\n\n if (document.readyState === 'loading') {\n document.addEventListener('DOMContentLoaded', init);\n } else {\n init();\n }\n\n}());\n<\/script>\n<\/body>\n<\/html>\n\n\n","protected":false},"excerpt":{"rendered":"<p>NORMAL MINIMAL CHANGE DISEASE GBM fenestrated endothelium podocyte cell body foot processes interdigitated slit diaphragm intact Normal filtration barrier GBM (normal on LM) fenestrated endothelium podocyte cell body slit diaphragm lost foot processes fused \/ effaced seen only on EM \u2014 LM is normal ↑ protein leak → nephrotic syndrome Electron-microscopy schematic. Normal: podocyte foot… <\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[24],"tags":[],"class_list":["post-36707","post","type-post","status-publish","format-standard","hentry","category-neet-pg"],"yoast_head":"\n<title>Paediatric Nephrotic Syndrome - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/04\/27\/paediatric-nephrotic-syndrome\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Paediatric Nephrotic Syndrome - atsixty\" \/>\n<meta property=\"og:description\" content=\"NORMAL MINIMAL CHANGE DISEASE GBM fenestrated endothelium podocyte cell body foot processes interdigitated slit diaphragm intact Normal filtration barrier GBM (normal on LM) fenestrated endothelium podocyte cell body slit diaphragm lost foot processes fused \/ effaced seen only on EM \u2014 LM is normal ↑ protein leak → nephrotic syndrome Electron-microscopy schematic. 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