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Complications of primary nephrotic syndrome in children

May 23, 2017

Infection is the most common complication and the main cause of death. According to statistics, the direct or indirect infection deaths account for 70% of the deaths in children with nephrosis. Infection is often the cause and precursor of repeated and / or aggravated illness, and can affect the efficacy of hormones. In bacterial infection, the main pathogens were cocci, and the infection caused by bacilli increased (E. coli) in recent years. There is a common respiratory infection, urinary tract infection, skin erysipelas and primary. Generally do not advocate preventive use of antibiotics, because the effect is not reliable, but also easy to cause drug-resistant bacteria proliferation and flora imbalance; but once infection occurs, should be timely and active treatment.
Hypercoagulable state and thromboembolic complications of nephropathy in coagulation and fibrinolytic system changes as follows: fibrinogen; increase the plasma coagulation factor V and VIII; antithrombin III decreased; decrease of plasma plasminogen activity; platelet count can increase the adhesion and aggregation. The result can lead to hypercoagulability and thrombosis complications, especially renal vein thrombosis. The acute case presented with a sudden attack of gross hematuria and abdominal pain, with tenderness of the rib ribs and swelling of the renal region, and bilateral acute renal failure. The clinical symptoms of chronic renal vein thrombosis are not obvious, usually only for edema and proteinuria. X-ray examination showed enlargement of the kidney and ureteral notch. B Ultrasound can sometimes be detected, when necessary to confirm the diagnosis of renal vein. In addition to renal vein, the other parts of the vein or artery can also occur such complications, such as femoral vein, femoral artery, pulmonary artery, mesenteric artery, coronary artery and intracranial artery, and cause corresponding symptoms. When the blood is taken out of the vein and the blood is easy to coagulate, the possibility of hypercoagulability should be considered. The easiest way is to determine the fibrinogen and platelet count by screening, and then measure other indexes.
Calcium and vitamin D metabolic disorders, kidney, blood vitamin D binding protein (VDBP, molecular weight 59000) lost in urine, vitamin D deficiency in vivo, affecting intestinal calcium absorption, and feedback lead to hyperparathyroidism. The clinical manifestations of vitamin D deficiency, hypocalcemia, circulating bone hypocalcification. These changes are particularly prominent in children during the growing period. Low blood volume due to plasma albumin, low plasma colloid osmotic pressure is reduced, the syndrome often have insufficient blood volume, some children of long-term inappropriate to avoid salt, when there is a sharp loss of body fluids (such as vomiting, diarrhea, diuresis, application of large volume paracentesis etc.) can appear different degree of hypovolemia the symptoms, such as orthostatic hyponatremia, prerenal azotemia, and even.
Transient mild renal failure is not uncommon when transient onset of mild hypoxemia occurs. Acute renal failure may occur in the course of the disease. The reasons are low blood volume and inappropriate necrosis. Severe renal interstitial edema, renal tubules are blocked by protein tubes, resulting in elevated hydrostatic pressure in the renal capsule and proximal tubule and decreased glomerular filtration. Drug induced tubulointerstitial lesions. Bilateral renal static thrombosis. Renal tubular dysfunction can be manifested as diabetes, amino acid urine, loss of potassium in the urine, loss of phosphorus, concentration, insufficiency of function, etc.


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