Kalra Suprita, Daryani Hitesh, Saxena Apoorv, Bhandari Sumit, Sharma Shobha
Associate Professor (Pediatrics), Army Hospital (R&R), New Delhi, India.
Pediatrician (Pediatrics), INHS Ashvini, Mumbai, India.
Med J Armed Forces India. 2022 Apr;78(2):170-174. doi: 10.1016/j.mjafi.2020.10.010. Epub 2020 Dec 29.
Sixty percent of children with nephrotic syndrome have frequently relapsing or steroid-dependent course. Serious infections like peritonitis, cellulitis, pneumonia etc. and anasarca with reduced urine output and complications there of including acute kidney injury and thromboembolism contribute significantly to morbidity and mortality in these children.
Questionnaire-based module to study infectious complications in children with nephrotic syndrome was circulated through survey monkey portal to paediatric nephrologists in our country. Twenty-two responded. Forty percent said that they saw patients with severe infections once a month. Fish bone analysis conducted on such patients reporting to our centre over next 3 months revealed that only 22% regularly monitored urine protein by dipstick. We proposed that reduction in time to report relapse by regularly monitoring urine protein could reduce complications in these children. Six urine protein dipsticks were handed over to patients who presented >7 days since relapse or with severe infection or anasarca in the last 1 year. These children were followed up for the next 1 year and given six more urine dipsticks every 3 months.
Twenty-three patients were given urine protein dipsticks. Nine of them had 12 severe complications in the previous 6 months. None had any serious infections/anasarca on follow-up. Sixteen new patients had 14 serious complications in this time.
Early detection of relapse by home monitoring of urine protein by dipsticks was effective in significantly reducing the number of patients with severe infections and anasarca with reduced urine output.
60%的肾病综合征患儿病情频繁复发或依赖类固醇治疗。腹膜炎、蜂窝织炎、肺炎等严重感染以及尿量减少的全身性水肿及其并发症（包括急性肾损伤和血栓栓塞）是这些患儿发病和死亡的重要原因。
通过SurveyMonkey平台向我国儿科肾病专家发放基于问卷的模块，以研究肾病综合征患儿的感染并发症。22人回复。40%的人表示他们每月会见到一次患有严重感染的患者。对接下来3个月到我们中心就诊的此类患者进行鱼骨分析发现，只有22%的人定期用试纸监测尿蛋白。我们提出，通过定期监测尿蛋白来缩短复发报告时间可以减少这些患儿的并发症。将6个尿蛋白试纸交给那些自复发以来超过7天就诊或在过去1年中患有严重感染或全身性水肿的患者。对这些患儿进行了为期1年的随访，每3个月再给他们6个尿试纸。
23名患者被给予尿蛋白试纸。其中9人在之前6个月中有12次严重并发症。随访期间无人发生任何严重感染/全身性水肿。16名新患者在此期间有14次严重并发症。
通过在家用试纸监测尿蛋白来早期发现复发，可有效显著减少严重感染和尿量减少的全身性水肿患者的数量。
