Analysis and modification of approaches to intensive care of critical complications of nephrotic syndrome in children

According to the World Association of Pediatric Nephrologists, the incidence of primary nephrotic syndrome (NS) is 3-12 cases per 100,000 children and tends to increase. The number of patients with a progressive course of the disease is growing every year, and nephrotic syndrome with severe proteinuria, hypoalbuminemia, anasarca occurs in 2-4 per 10,000 children under the age of 16.

BACKGROUND: analysis and modification of approaches to intensive care of critical complications of nephrotic syndrome in children.

PATIENTS AND METHODS: A clinical and laboratory examination of 120 sick children suffering from NS was carried out. In accordance with international standards, the patients were divided into SRNS and SRNS in accordance with the response to the standard course of steroid therapy (prednisone 60 mg/m²/day).

RESULTS: Based on the results of our study and on the basis of a correlation analysis of the indicators of renal sodium retention with parameters reflecting volemic disorders in generalized edema in children with HCNS and SRNS, it was possible to establish clinical and functional criteria for the nature of the causes of edema (Figure 6). At the same time, mainly this group (in 11 cases – 45%) with refractory edema consisted mainly of children with HCV, in whom critical hypoalbuminemia (less than 15 g / l in plasma), critical renal sodium retention (FENa <0.2%) and intravascular reduction in fluid volume (hypovolemia: decrease average indices of the index of the area of the NIP, volumetric blood flow through the inferior vena cava and renal veins against the background of a decrease in the diastolic index of the left ventricle, shock and cardiac indices).

CONCLUSION: in children with nephrotic edema of normovolemic and hypervolemic variants with steroid-resistant NS occurring with arterial hypertension, oliguria and a decrease in the glomerular filtration index of the kidneys, high efficacy of furosemide at a dose of 3-5 mg/ kg of body weight and the absence of a reliable effect of albumin and colloidal solutions were noted when relieving generalized edema, which excludes the use of the latter in our recommendations on the revision of approaches to intensive care of NS in children.

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