Etiology, diagnosis and treatment of nephrotic syndrome in children

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Nephrotic syndrome can be divided into three categories: primary, secondary and congenital. The etiology of primary nephrotic syndrome is un

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Nephrotic syndrome can be divided into three categories: primary, secondary and congenital. The etiology of primary nephrotic syndrome is unknown. Secondary nephrotic syndrome refers to appear in the primary disease based on clear diagnosis of nephrotic syndrome, can appear in such as allergic purpura, hepatitis, systemic lupus erythematosus, dermatomyositis, hemolytic uremic syndrome and other diseases in the process of comprehensive. Congenital kidney disease: most in the neonatal period or within 3 months after the birth of nephrotic syndrome, a few in the onset of the disease within the age of 1. No good treatment, the prognosis is poor. In children, the incidence of primary nephrotic syndrome is high, accounting for about 20% of the urinary tract disease in children. Diagnosis of nephrotic syndrome

1 to determine whether nephrotic syndrome

The diagnosis was made by urine routine, 24 hours urine protein quantitation, plasma albumin and blood lipid level

2 determine the cause

Are the primary, secondary, or genetic causes identified by clinical and laboratory tests?

3 clinical classification diagnosis

According to whether the children with hematuria, hypertension, renal insufficiency and low blood pressure is clear or simple type of nephritis.

4 hormone efficacy determination

According to the situation of children with steroid negative urinary protein after treatment, determine the children is hormone sensitive or hormone resistance?

5 determine the type of renal pathology

For a variety of secondary or suspected hereditary, or clinical manifestations of nephritis type, or the effect of hormone therapy in children with poor renal biopsy is recommended to determine the type of renal pathology, in order to give accurate treatment.

6 to determine whether the presence of complications in children

The common complications including infection, thrombosis, electrolyte disorder, acute renal insufficiency.

Two, nephrotic syndrome common complications

1 the most common is the infection, can occur in the respiratory tract, digestive tract, skin, urinary system, etc..

Respiratory tract infection: clinical manifestations were cough, sore throat, fever, need to check the blood routine. Severe chest radiography. Such as long-term low fever, need to check tuberculosis.

Digestive tract infection: for vomiting, abdominal pain, diarrhea, mucous stool, stool and blood routine to check.

Skin infection: skin redness, local pain, swelling, etc..

Urinary tract infections: characterized by frequent urination, urgency dysuria and fever, sometimes need to check the urine after blood, urine routine and urine culture.

Other: conjunctivitis, urethral stomatitis etc..

Preventive measures: oral care, urethral mouth care, hand washing, ventilation, food hygiene, keep skin clean, pay attention to a skin care.

2 thrombus

Nephrotic syndrome is not relieved, it is in hypercoagulable state.

This is a very serious complication that can be life-threatening. Thrombosis can occur in the lung, brain, renal vein, lower extremity arteries and veins, mesenteric blood vessels, etc..

Pulmonary embolism: not uncommon, manifestations of fatigue, chest tightness, shortness of breath, cough, hemoptysis, severe cases of sudden death, pulmonary artery CT examination can be diagnosed.

Cerebral embolism: headache, vomiting, and even convulsions, cranial vascular examination can be diagnosed.

Renal vein thrombosis: can be manifested as low back pain, gross hematuria, bilateral kidneys ranging from vigilance, renal vascular ultrasound or CT examination can help.

Lower extremity arterial thrombosis: limb pain, feeling numb, cold limb lesions, movement disorder etc..

Venous thrombosis of lower extremities: swelling of the affected side.

Mesenteric vascular embolization: abdominal pain, intractable ascites. Severe bowel wall necrosis, peritonitis.

Preventive measures: nephrotic syndrome in remission when anticoagulation therapy, prevention of thrombosis, commonly used drugs: dipyridamole, heparin. When the occurrence of vomiting and diarrhea timely rehydration, prevent blood concentration.

3 low blood volume shock

For serious complications, life-threatening.

Good hair in nephrotic syndrome did not ease, and poor eating, drinking less, vomiting diarrhea.

Performance: poor spirit, weakness, cold hands and feet, blood pressure drop or not.

Preventive measures: to ensure that children eat and drink the basic amount, such as vomiting and diarrhea, timely fill with salt solution.

4 hypokalemia, hyponatremia, etc.

Good at eating, vomiting and diarrhea.

Performance: poor spirit, lack of power, etc..

Prevention: to ensure that the basic food intake, vomiting and diarrhea when adding salt solution.

5 acute renal insufficiency

Can reduce the amount of urine, blood pressure, increased serum creatinine.

Three, the initial treatment after diagnosis of nephrotic syndrome

1 after the diagnosis given enough hormone therapy to exclude tuberculosis infection and other serious infections (commonly used prednisone or prednisolone) for at least 4 weeks.

2 taking calcium and vitamin D.

3 such as the need for aggressive treatment of infection.

4 if there is a hypercoagulable state anticoagulant therapy to prevent thrombosis.

5 if there is electrolyte disorder need to be corrected.

6 edema and urine volume reduction should be appropriate to control the intake of water.

7 in the remission of nephrotic syndrome, it is suggested that the low salt, low fat, low protein diet can be gradually restored to normal diet.

8 children vomiting and diarrhea obviously requires timely rehydration therapy, to avoid life-threatening hypovolemic shock.

Children with nephrotic syndrome in the treatment cycle is longer, easily repeated, side effects of long-term oral hormone is large, the whole course of treatment, often according to the duration of treatment, the therapeutic effect and no infection such as adjusting drug dosage. Parental involvement and good compliance are important to the success of treatment. Nephrotic syndrome to children and their families to bring psychological pressure is obvious, good communication between doctors and patients as well as the doctor's humanistic care is the best way to resolve the pressure.

 

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