Obtain vital signs.

An elevated blood pressure may indicate significant renal involvement.

Plot height and weight on an appropriated growth chart.

Short statue can indicate significant renal disease. Proteinuria could be a marker for renal hypoplasia/dysplasia.

Observe for periorbital edema, presacral edema, ascites, and dependent edema.

Remember if the child has been in bed, presacral edema may be the most prominent. Periorbital edema is most prominent in the morning. A fluid wave, shifting dullness, and genital edema are signs of ascites.

Check the lungs carefully for decreased breath sounds.

Remember that massive edema often leads to pleural effusions. Do not forget to percuss the chest. If a pleural effusion is due to nephrotic syndrome, ascites should also be present.

Perform a careful abdominal examination.

One is looking for ascites.  Check the belt line for impressions.  Remember the liver may be enlarged as a result of massive proteinuria.

Examine the extremities carefully for edema.

Check sock lines for impressions indicating subcutaneous edema.

Examine the skin carefully.

Rashes are always important to evaluate in the face of potential nephritis/nephrotic syndrome. Remember the skin may appear pale as a result of subcutaneous edema. If the patient is clearly nephrotic, always inspect the skin for signs of tissue breakdown and potential cellulitis.