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http://dx.doi.org/10.3345/kjp.2011.54.8.322

Complications of nephrotic syndrome  

Park, Se-Jin (Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine)
Shin, Jae-Il (The Institute of Kidney Disease, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.54, no.8, 2011 , pp. 322-328 More about this Journal
Abstract
Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS.
Keywords
Nephrotic syndrome; Complications; Proteinuria; Child;
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1 Davison AM, Cameron JS, Grunfeld JP, Ponticelli C, Ritz E, Winearls CG, et al. Oxford textbook of clinical nephrology. 3rd ed. New York: Oxford University Press, 2005;421.
2 Gulati S, Kher V, Gulati K, Arora P, Gujral R. Tuberculosis in childhood nephrotic syndrome in India. Pediatr Nephrol 1997;11:695-8.
3 Gorensek MJ, Lebel MH, Nelson JD. Peritonitis in children with nephrotic syndrome. Pediatrics 1988;81:849-56.
4 Latta K, von Schnakenburg C, Ehrich JH. A meta-analysis of cytotoxic treatment for frequently relapsing nephrotic syndrome in children. Pediatr Nephrol 2001;16:271-82.   DOI   ScienceOn
5 Ellis D. Anemia in the course of the nephrotic syndrome secondary to transferrin depletion. J Pediatr 1977;90:953-5.   DOI
6 Vaziri ND. Erythropoietin and transferrin metabolism in nephrotic syndrome. Am J Kidney Dis 2001;38:1-8.
7 Toubiana J, Schlageter MH, Aoun B, Dunand O, Vitkevic R, Bensman A, et al. Therapy-resistant anaemia in congenital nephrotic syndrome of the Finnish type--implication of EPO, transferrin and transcobalamin losses. Nephrol Dial Transplant 2009;24:1338-40.
8 Agarwal N, Phadke KD, Garg I, Alexander P. Acute renal failure in children with idiopathic nephrotic syndrome. Pediatr Nephrol 2003;18:1289-92.   DOI   ScienceOn
9 Raij L, Keane WF, Leonard A, Shapiro FL. Irreversible acute renal failure in idiopathic nephrotic syndrome. Am J Med 1976;61:207-14.   DOI   ScienceOn
10 Lowenstein J, Schacht RG, Baldwin DS. Renal failure in minimal change nephrotic syndrome. Am J Med 1981;70:227-33.   DOI   ScienceOn
11 Vande Walle JG, Donckerwolcke RA. Pathogenesis of edema formation in the nephrotic syndrome. Pediatr Nephrol 2001;16:283-93.   DOI   ScienceOn
12 Muranjan MN, Kher AS, Nadkarni UB, Kamat JR. Congenital nephrotic syndrome with clinical hypothyroidism. Indian J Pediatr 1995;62:233-5.   DOI   ScienceOn
13 Goldstein DA, Haldimann B, Sherman D, Norman AW, Massry SG. Vitamin D metabolites and calcium metabolism in patients with nephrotic syndrome and normal renal function. J Clin Endocrinol Metab 1981;52:116-21.   DOI
14 Sato KA, Gray RW, Lemann J Jr. Urinary excretion of 25-hydroxyvitamin D in health and the nephrotic syndrome. J Lab Clin Med 1982;99:325- 30.
15 Appel GB, Blum CB, Chien S, Kunis CL, Appel AS. The hyperlipidemia of the nephrotic syndrome. Relation to plasma albumin concentration, oncotic pressure, and viscosity. N Engl J Med 1985;312:1544-8.   DOI   ScienceOn
16 Prescott WA Jr, Streetman DA, Streetman DS. The potential role of HMG-CoA reductase inhibitors in pediatric nephrotic syndrome. Ann Pharmacother 2004;38:2105-14.   DOI   ScienceOn
17 Bruckert E, Hayem G, Dejager S, Yau C, Begaud B. Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients--the PRIMO study. Cardiovasc Drugs Ther 2005;19:403-14.   DOI   ScienceOn
18 Baer AN, Wortmann RL. Myotoxicity associated with lipid-lowering drugs. Curr Opin Rheumatol 2007;19:67-73.
19 Wang SJ, Tsau YK, Lu FL, Chen CH. Hypovolemia and hypovolemic shock in children with nephrotic syndrome. Acta Paediatr Taiwan 2000;41:179-83.
20 Donckerwolcke RA, France A, Raes A, Vande Walle J. Distal nephron sodium-potassium exchange in children with nephrotic syndrome. Clin Nephrol 2003;59:259-66.   DOI
21 Matsumoto H, Miyaoka Y, Okada T, Nagaoka Y, Wada T, Gondo A, et al. Ratio of urinary potassium to urinary sodium and the potassium and edema status in nephrotic syndrome. Intern Med 2011;50:551-5.   DOI   ScienceOn
22 Rabelink TJ, Zwaginga JJ, Koomans HA, Sixma JJ. Thrombosis and hemostasis in renal disease. Kidney Int 1994;46:287-96.   DOI   ScienceOn
23 Llach F. Hypercoagulability, renal vein thrombosis, and other thrombotic complications of nephrotic syndrome. Kidney Int 1985;28:429-39.   DOI   ScienceOn
24 Lau SO, Tkachuck JY, Hasegawa DK, Edson JR. Plasminogen and antithrombin III deficiencies in the childhood nephrotic syndrome associated with plasminogenuria and antithrombinuria. J Pediatr 1980;96(3 Pt 1):390-2.   DOI
25 Ozsoylu S, Strauss HS, Diamond LK. Effects of corticosteroids on coagulation of the blood. Nature 1962;195:1214-5.   DOI
26 Lilova MI, Velkovski IG, Topalov IB. Thromboembolic complications in children with nephrotic syndrome in Bulgaria (1974-1996). Pediatr Nephrol 2000;15:74-8.   DOI   ScienceOn
27 Witz M, Korzets Z. Renal vein occlusion: diagnosis and treatment. Isr Med Assoc J 2007;9:402-5.
28 Huang J, Yang J, Ding J. Pulmonary embolism associated with nephrotic syndrome in children: a preliminary report of 8 cases. Chin Med J (Engl) 2000;113:251-3.
29 Lechner BL, Bockenhauer D, Iragorri S, Kennedy TL, Siegel NJ. The risk of cardiovascular disease in adults who have had childhood nephrotic syndrome. Pediatr Nephrol 2004;19:744-8.   DOI   ScienceOn
30 Zilleruelo G, Hsia SL, Freundlich M, Gorman HM, Strauss J. Persistence of serum lipid abnormalities in children with idiopathic nephrotic syndrome. J Pediatr 1984;104:61-4.   DOI
31 Tain YL, Lin G, Cher TW. Microbiological spectrum of septicemia and peritonitis in nephrotic children. Pediatr Nephrol 1999;13:835-7.   DOI   ScienceOn
32 Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders, 2007;2193-4.
33 Tejani A, Fikrig S, Schiffman G, Gurumurthy K. Persistence of protective pneumococcal antibody following vaccination in patients with the nephrotic syndrome. Am J Nephrol 1984;4:32-7.   DOI   ScienceOn
34 Alpay H, Yildiz N, Onar A, Temizer H, Ozçay S. Varicella vaccination in children with steroid-sensitive nephrotic syndrome. Pediatr Nephrol 2002;17:181-3.   DOI   ScienceOn
35 Kato S, Chernyavsky S, Tokita JE, Shimada YJ, Homel P, Rosen H, et al. Relationship between proteinuria and venous thromboembolism. J Thromb Thrombolysis 2010;30:281-5.   DOI   ScienceOn
36 Ulinski T, Guigonis V, Baudet-Bonneville V, Auber F, Garcette K, Bensman A. Mesenteric thrombosis causing short bowel syndrome in nephrotic syndrome. Pediatr Nephrol 2003;18:1295-7.   DOI   ScienceOn
37 Cade R, Spooner G, Juncos L, Fuller T, Tarrant D, Raulerson D, et al. Chronic renal vein thrombosis. Am J Med 1977;63:387-97.   DOI   ScienceOn
38 Cho MH, Hwang HH, Choe BH, Kwon SH, Ko CW, Kim JY, et al. The reversal of intussusception associated with nephrotic syndrome by infusion of albumin. Pediatr Nephrol 2009;24:421-2.   DOI   ScienceOn
39 Hodson EM, Willis NS, Craig JC. Corticosteroid therapy for nephrotic syndrome in children. Cochrane Database Syst Rev 2007;(4):CD001533.
40 Grenda R, Webb NJ. Steroid minimization in pediatric renal transplantation: early withdrawal or avoidance? Pediatr Transplant 2010; 14:961-7.   DOI   ScienceOn
41 Dong F, Ren J. Insulin-like growth factors (IGFs) and IGF-binding proteins in nephrotic syndrome children on glucocorticoid. Pharmacol Res 2003;48:319-23.   DOI   ScienceOn
42 Zhou X, Loke KY, Pillai CC, How HK, Yap HK, Lee KO. IGFs and IGF-binding proteins in short children with steroid-dependent nephrotic syndrome on chronic glucocorticoids: changes with 1 year exogenous GH. Eur J Endocrinol 2001;144:237-43.   DOI   ScienceOn
43 Dong F, Zhou X, Pang N, Wei M. Effect of glucocorticoid treatment on insulin like growth factor-I and its binding proteins in children with nephrotic syndrome. Chin Med J (Engl) 2002;115:1383-5.
44 Bernard DB. Extrarenal complications of the nephrotic syndrome. Kidney Int 1988;33:1184-202.   DOI   ScienceOn
45 Gea-Banacloche JC. Rituximab-associated infections. Semin Hematol 2010;47:187-98.   DOI   ScienceOn
46 Abe T, Ichimaru N, Kakuta Y, Okumi M, Imamura R, Isaka Y, et al. Long-term outcome of pediatric renal transplantation: a single center experience. Clin Transplant 2011;25:388-94.   DOI   ScienceOn
47 Jeon SH, Lim AY, Kim YK, Cheon HW, Yoo KH, Hong YS, et al. The effect of steroid therapy on growth and bone density in children with nephrotic syndrome. J Korean Pediatr Soc 1998;41:1396-1402.
48 Hall AS, Thorley G, Houtman PN. The effects of corticosteroids on behavior in children with nephrotic syndrome. Pediatr Nephrol 2003;18:1220-3.   DOI   ScienceOn
49 Ueda N, Kuno K, Ito S. Eight and 12 week courses of cyclophosphamide in nephrotic syndrome. Arch Dis Child 1990;65:1147-50.   DOI   ScienceOn
50 Truffa-Bachi P, Lefkovits I, Frey JR. Proteomic analysis of T cell activation in the presence of cyclosporin A: immunosuppressor and activator removal induces de novo protein synthesis. Mol Immunol 2000;37:21-8.   DOI   ScienceOn
51 Chishti AS, Sorof JM, Brewer ED, Kale AS. Long-term treatment of focal segmental glomerulosclerosis in children with cyclosporine given as a single daily dose. Am J Kidney Dis 2001;38:754-60.   DOI   ScienceOn
52 Bertani T, Perico N, Abbate M, Battaglia C, Remuzzi G. Renal injury induced by long-term administration of cyclosporin A to rats. Am J Pathol 1987;127:569-79.
53 Kim JH, Park SJ, Yoon SJ, Lim BJ, Jeong HJ, Lee JS, et al. Predictive factors for ciclosporin-associated nephrotoxicity in children with minimal change nephrotic syndrome. J Clin Pathol 2011;64:516-9.   DOI   ScienceOn
54 Iijima K, Hamahira K, Tanaka R, Kobayashi A, Nozu K, Nakamura H, et al. Risk factors for cyclosporine-induced tubulointerstitial lesions in children with minimal change nephrotic syndrome. Kidney Int 2002;61:1801-5.   DOI   ScienceOn
55 Fujinaga S, Kaneko K, Muto T, Ohtomo Y, Murakami H, Yamashiro Y. Independent risk factors for chronic cyclosporine induced nephropathy in children with nephrotic syndrome. Arch Dis Child 2006;91:666-70.   DOI   ScienceOn
56 Yang CW, Ahn HJ, Kim WY, Li C, Kim HW, Choi BS, et al. Cyclosporine withdrawal and mycophenolate mofetil treatment effects on the progression of chronic cyclosporine nephrotoxicity. Kidney Int 2002;62:20-30.   DOI   ScienceOn
57 Hara S, Umino D, Someya T, Fujinaga S, Ohtomo Y, Murakami H, et al. Protective effects of Mizoribine on Cyclosporine A nephropathy in rats. Pediatr Res 2009;66:524-7.   DOI   ScienceOn
58 Aiyangar A, Rajput P, Shah BV. Mycophenolate induced diarrhoea. J Assoc Physicians India 2010;58:192-4.
59 De Rycke A, Dierickx D, Kuypers DR. Tacrolimus-induced neutropenia in renal transplant recipients. Clin J Am Soc Nephrol 2011;6:690-4.   DOI   ScienceOn
60 Bagga A, Sinha A, Moudgil A. Rituximab in patients with the steroidresistant nephrotic syndrome. N Engl J Med 2007;356:2751-2.   DOI
61 Ulinski T, Aoun B. Pediatric idiopathic nephrotic syndrome: treatment strategies in steroid dependent and steroid resistant forms. Curr Med Chem 2010;17:847-53.   DOI   ScienceOn
62 Schrier RW, Gottschalk CW. Diseases of the Kidney. 4th ed. Boston: Little, Brown, 1988;1749, 1899.