1. Believe parents when they said their kid looks puffy.
2. If the chief complaint is swelling/puffiness, especially periorbital or dependent, get a Urinalysis (UA).
3. If UA is concerning for Nephrotic Syndrome (NS) (ie, heavy proteinuria), get Urine protein/Cr ratio, lipid panel, RFP and then call nephrology.
4. Fever in patients with NS is a serious bacterial infection until proven otherwise. Get blood and urine cultures and start empiric antibiotics.
5. Spontaneous Bacterial Peritonitis and thromboembolism are well known complications in patients with NS. You must have a high suspision for them to make the diagnosis.
6. Most of these children with require admission to the hospital.