Clinical study of five cases requiring hemodialysis at initial onset of pediatric idiopathic nephrotic syndrome

Abstract

We have examined clinically five cases of acute kidney injury in pediatric idiopathic nephrotic syndrome (NSAKI) that required hemodialysis (HD) at onset. This cohort comprised four boys and a girl aged between one and three years. HD was indicated in all cases due to oliguria/anuria and in two cases due to respiratory failure. The average weight gain rate was 46%. Two cases started HD within 2 weeks of NS onset, and three cases started approximately one month after. Renal histological findings were minimal-change type in three cases and focal segmental glomerulosclerosis (FSGS) in one case. The average duration of HD was 16 days, ranging from 6 to 42 days. Two patients transitioned from HD to peritoneal dialysis (PD), but one patient could be withdrawn from PD and had no renal dysfunction at final observation. A patient with FSGS developed end-stage renal failure, and underwent renal transplant. It must be noted that there are two timings for the onset of NSAKI: the early episode and the refractory stages of steroid therapy. Furthermore, it’s suggested in NSAKI that the prompt introduction of HD might be able to prevent permanent renal dysfunction by focusing on urine volume and weight gain rate rather than serum creatinine levels.