Primary nephrotic syndrome in children

　　The etiology of primary nephrotic syndrome is unclear, and its onset is often triggered by respiratory tract infections, allergic reactions, and other factors, with symptoms including large amounts of proteinuria, hypoalbuminemia, edema, and protein malnutrition.

　　The main complications of primary nephrotic syndrome in children are infection, acute renal failure, renal tubular dysfunction, adrenal cortical crisis, calcium and vitamin D metabolism disorders, atherosclerosis, etc.

　　The main symptoms of primary nephrotic syndrome in children are mainly the following aspects:

　　1, Large amounts of proteinuria and hypoalbuminemia.

　　2, Edema.Edema is凹性. It starts from the eyelids and face, gradually spreads to the limbs and the whole body, and at the same time, the urine output decreases. The child may have serous cavity effusion such as pleural effusion and ascites. Boys often have significant scrotal edema. In severe cases of edema, white or purple streaks can be seen on the skin of the inner thigh and upper arm and abdominal wall.

　　3, Protein malnutrition.The child's skin is dry, pale, hair dry and withered, white transverse stripes appear on the nails of the fingers and toes, and the ear shell and nasal cartilage are thin. The child may have listlessness, fatigue, decreased appetite, or diarrhea due to factors such as edema and infection of the intestinal mucosa.

　　Children's hernia disease not only seriously affects the daily life of patients, but also, if left untreated for a long time, can lead to other diseases. Therefore, the prevention of this disease is particularly important. The following points should be noted during prevention:

　　1, Reasonably arrange daily life and exercise, while avoiding overwork.

　　2, Ensure a balanced diet, enhance physical fitness and body resistance.

　　3, Pay attention to personal hygiene and environmental cleanliness.

　　4, Maintain a relaxed and pleasant mood, and strengthen self-care awareness.

　　5, Actively prevent and treat infection foci, and actively prevent chronic kidney disease.

　　The diagnosis of primary nephrotic syndrome in children relies not only on clinical manifestations but also on chemical tests. The main methods of examination include the following:

　　1, Blood routine

　　1, Hyperlipidemia: Hyperlipidemia is mainly hypercholesterolemia and hypertriglyceridemia. Blood cholesterol ≥5.7mmol/L, infants ≥5.2mmol/L, triglycerides >1.2mmol/L.

　　2, Hypoalbuminemia: Plasma albumin

　　2, Renal function

　　Generally normal. Urea nitrogen slightly elevated during oliguria.

　　3, Urinalysis

　　24h urine protein quantification ≥50-100mg/(kg·d). Infants can be tested for any urine protein/creatinine ratio > 2.0.

　　4, Other

　　1, X-ray examination: X-ray can detect chronic renal vein thrombosis.

　　2, Ultrasound examination: Ultrasound can detect chronic renal vein thrombosis.

　　Primary nephrotic syndrome in children should be provided with sufficient calories to ensure a reasonable dietary structure. Salt intake should not be too low to avoid hyponatremia, and 1-2g of salt per day can be given. The protein intake should be 1-2g/(kg·d). In cases of renal failure, a low-protein diet is recommended. In addition, attention should be paid to the supplementation of various water-soluble vitamins and calcium, zinc, etc.

　　The routine methods of Western medicine for the treatment of primary nephrotic syndrome in children

　　Primary nephrotic syndrome in children not only seriously affects the daily life of patients, but also, if prolonged, can lead to other diseases, so active treatment should be carried out. The main treatment methods are as follows:

　　I. General Treatment1. Moderate Rest

　　: In general, except for patients with severe edema and concurrent infection, it is not necessary to remain in bed absolutely. After the condition improves, the amount of activity gradually increases. After 3-6 months of remission, one can gradually resume study, but it is advisable to avoid overexertion.2. Diet

　　: Low-salt diet. Patients with severe edema and high blood pressure should avoid salt. Children with severe edema and oliguria should appropriately limit water intake, but when there is significant diuresis or loss of salt due to diarrhea or vomiting, appropriate salt and water should be supplemented.

　　II. Symptomatic Treatment

　　III. Adrenal Cortex Hormone Treatment (hereinafter referred to as hormones): Generally, within 7-14 days after the application of hormones, most children begin to diurese and reduce edema, so diuretics may not be needed. High edema, concurrent skin infection, hypertension, and patients insensitive to hormones often require diuretics.

　　Hormones can induce the disappearance of proteinuria and can be used as the first-line drug for kidney disease treatment. When hormone resistance occurs, attention should be paid to whether there are other factors affecting it, such as the presence of infection, tubulointerstitial changes, renal vein thrombosis, or the concurrent use of drugs that affect the efficacy of hormones, such as phenytoin sodium or rifampicin, etc.

　　IV. Immunosuppressant Treatment

　　For patients with refractory kidney disease and severe side effects of hormones, immunosuppressants can be added or switched. Common immunosuppressants include cyclophosphamide, busulfan, nitrogen mustard hydrochloride, cyclosporin A, tripterygium glycosides, etc.

　　V. Other Treatments

　　1. Application of Anticoagulants: In nephrotic syndrome, a hypercoagulable state often occurs, so in recent years, some people have advocated the addition of anticoagulants or antiplatelet aggregation agents, such as heparin, dipyridamole, and traditional Chinese medicine Salvia miltiorrhiza, etc.

　　2. Levamisole: Levamisole is an immunomodulator. It is generally used for hormone-assisted treatment, especially for cases with recurrent infection or hormone dependence. After use, it can reduce concurrent respiratory tract infections and reduce the dosage of hormones for hormone-dependent individuals.

　　3. Proglumetacin: Proglumetacin is an angiotensin II receptor antagonist, which can improve the hemodynamic state of glomerular blood vessels and reduce the excretion of urinary protein, and can be used for hormone-assisted treatment.