outpatient by a specialist to monitor weight, blood pressure, and response to therapy In children in whom infection is suspected, appropriate antibiotics with coverage for S pneumoniae and gram-negative bacterial infections should be provided Though children with nephrotic syndrome are at risk for thromboembolic complications, there is no clear evidence supporting prophylactic anticoagulation Supportive measures to reduce the risk of thromboembolism include mobilization and avoiding intravascular volume depletion If thrombosis does occur, anticoagulation should be initiated As for long-term management of nephrotic syndrome, identification of the underlying cause is necessary Greater than 90% of patients with MCD will respond to glucocorticoid therapy Given the high frequency of MCD as the cause of idiopathic nephrotic syndrome and the favorable response of MCD to glucocorticoid therapy, an empiric trial of glucocorticoid therapy without confirmatory pathology is often provided to prepubertal children with suggestive clinical characteristics (between and 10 years of age at presentation; normal renal function, blood pressure, and complement levels; benign urine sediment) Adolescents are also considered for empiric therapy, though obtaining a renal biopsy prior to therapy or after a defined period of glucocorticoid therapy without response would be reasonable given the increased occurrence of FSGS, MPGN, and membranous nephropathy in this age group Patients with idiopathic nephrotic syndrome are further classified on the basis of their response to glucocorticoid therapy: glucocorticoid-responsive, glucocorticoid-dependent, and glucocorticoid-resistant nephrotic syndrome Patients with responsive disease have a favorable long-term prognosis, and those with resistant pattern have a more guarded prognosis CHRONIC KIDNEY DISEASE CLINICAL PEARLS AND PITFALLS