Nephrotic syndrome natural history, complications and prognosis: Difference between revisions
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==Complications== | ==Complications== | ||
===Infections=== | |||
* | Patients with nephrotic syndrome are at increased risk of infections due to several mechanisms: | ||
*Delay in complement-dependent opsonisation of encapsulated organisms, such as S. pneumoniae<ref name="pmid9745775">{{cite journal| author=Patiroglu T, Melikoglu A, Dusunsel R| title=Serum levels of C3 and factors I and B in minimal change disease. | journal=Acta Paediatr Jpn | year= 1998 | volume= 40 | issue= 4 | pages= 333-6 | pmid=9745775 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9745775 }} </ref> | |||
*Reduction in factors B and I<ref name="pmid9745775">{{cite journal| author=Patiroglu T, Melikoglu A, Dusunsel R| title=Serum levels of C3 and factors I and B in minimal change disease. | journal=Acta Paediatr Jpn | year= 1998 | volume= 40 | issue= 4 | pages= 333-6 | pmid=9745775 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9745775 }} </ref> | |||
Patients with nephrotic syndrome who complain of abdominal pain must always be assessed for peritonitis that requires paracentesis. The rate of spontaneous bacterial peritonitis is 2-6%<ref name="pmid3293444">{{cite journal| author=Feinstein EI, Chesney RW, Zelikovic I| title=Peritonitis in childhood renal disease. | journal=Am J Nephrol | year= 1988 | volume= 8 | issue= 2 | pages= 147-65 | pmid=3293444 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3293444 }} </ref> which contributed to 1-2% of mortality in these patients. Gram-negative bacterial organisms, such as E. coli, are especially important infectious agents in patients with nephrotic syndrome.<ref name="pmid10603131">{{cite journal| author=Tain YL, Lin G, Cher TW| title=Microbiological spectrum of septicemia and peritonitis in nephrotic children. | journal=Pediatr Nephrol | year= 1999 | volume= 13 | issue= 9 | pages= 835-7 | pmid=10603131 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10603131 }} </ref> Urinary tract infections and skin infections are also common, such as cellulitis, erysipelas, and lymphangitis.<ref name="pmid12944064">{{cite journal| author=Eddy AA, Symons JM| title=Nephrotic syndrome in childhood. | journal=Lancet | year= 2003 | volume= 362 | issue= 9384 | pages= 629-39 | pmid=12944064 | doi=10.1016/S0140-6736(03)14184-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12944064 }} </ref> Since patients are often treated with immunosuppressants, the susceptibility to infections is further heightened in these patients.<ref name="pmid10775074">{{cite journal| author=Goldstein SL, Somers MJ, Lande MB, Brewer ED, Jabs KL| title=Acyclovir prophylaxis of varicella in children with renal disease receiving steroids. | journal=Pediatr Nephrol | year= 2000 | volume= 14 | issue= 4 | pages= 305-8 | pmid=10775074 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10775074 }} </ref><ref name="pmid9745775">{{cite journal| author=Patiroglu T, Melikoglu A, Dusunsel R| title=Serum levels of C3 and factors I and B in minimal change disease. | journal=Acta Paediatr Jpn | year= 1998 | volume= 40 | issue= 4 | pages= 333-6 | pmid=9745775 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9745775 }} </ref> | |||
==Prognosis== | ==Prognosis== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Complications
Infections
Patients with nephrotic syndrome are at increased risk of infections due to several mechanisms:
- Delay in complement-dependent opsonisation of encapsulated organisms, such as S. pneumoniae[1]
- Reduction in factors B and I[1]
Patients with nephrotic syndrome who complain of abdominal pain must always be assessed for peritonitis that requires paracentesis. The rate of spontaneous bacterial peritonitis is 2-6%[2] which contributed to 1-2% of mortality in these patients. Gram-negative bacterial organisms, such as E. coli, are especially important infectious agents in patients with nephrotic syndrome.[3] Urinary tract infections and skin infections are also common, such as cellulitis, erysipelas, and lymphangitis.[4] Since patients are often treated with immunosuppressants, the susceptibility to infections is further heightened in these patients.[5][1]
Prognosis
The prognosis depends on the cause of nephrotic syndrome. It is usually good in children, because minimal change disease responds very well to steroids and does not cause chronic renal failure. However, other causes such as focal segmental glomerulosclerosis frequently lead to end stage renal disease. Factors associated with a poorer prognosis in these cases include level of proteinuria, blood pressure control and kidney function (GFR).
References
- ↑ 1.0 1.1 1.2 Patiroglu T, Melikoglu A, Dusunsel R (1998). "Serum levels of C3 and factors I and B in minimal change disease". Acta Paediatr Jpn. 40 (4): 333–6. PMID 9745775.
- ↑ Feinstein EI, Chesney RW, Zelikovic I (1988). "Peritonitis in childhood renal disease". Am J Nephrol. 8 (2): 147–65. PMID 3293444.
- ↑ Tain YL, Lin G, Cher TW (1999). "Microbiological spectrum of septicemia and peritonitis in nephrotic children". Pediatr Nephrol. 13 (9): 835–7. PMID 10603131.
- ↑ Eddy AA, Symons JM (2003). "Nephrotic syndrome in childhood". Lancet. 362 (9384): 629–39. doi:10.1016/S0140-6736(03)14184-0. PMID 12944064.
- ↑ Goldstein SL, Somers MJ, Lande MB, Brewer ED, Jabs KL (2000). "Acyclovir prophylaxis of varicella in children with renal disease receiving steroids". Pediatr Nephrol. 14 (4): 305–8. PMID 10775074.