Materiały źródłowe

• #1 Nephrotic Syndrome in Children | National Kidney Foundation

  https://www.kidney.org/kidney-topics/nephrotic-syndrome-children

  Nephrotic syndrome in kids causes swelling and protein loss in urine. Managed with meds and a low-sodium diet. Monitoring is crucial for treatment. […] A low salt (sodium) diet to help limit the swelling in the body is often recommended for children with nephrotic syndrome. This is most important when there is protein leaking into the urine. A dietitian who works with the kidney doctor can provide recommendations.

• #2 Steroid-sensitive nephrotic syndrome in children: triggers of relapse and evolving hypotheses on pathogenesis | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-015-0123-9

  Nephrotic syndrome remains the most common manifestation of glomerular disease in childhood. […] Acute respiratory infections and urinary tract infections are the most frequent infectious triggers of relapse. Targeted interventions like initiating corticosteroid or its dose-adjustment during episodes of acute respiratory infection and zinc supplementation are reportedly effective in reducing relapse rates. […] Interestingly, the recent KDIGO Summary of Recommendation statements in the clinical practice Guideline for Glomerulonephritis advises that daily prednisolone be given during episodes of upper respiratory tract and other infections to reduce the risk for relapse in children with frequently relapsing and steroid dependent SSNS already on alternate day prednisolone. […] Identification of triggers of relapse in SSNS has led to targeted interventions which aim to ameliorate disease morbidity.

• #3

  https://journals.sbmu.ac.ir/jpn/article/view/32477

  Children with nephrotic syndrome (NS) develop complications due to either the disease state or its treatment. […] Infection is one of the common triggering factors for relapse, and prophylaxis against infections is required in patients unresponsive to steroids or with frequently relapsing disease. […] The most commonly studied drug for the prevention of infection in NS is intravenous immunoglobulin G (IVIg), while other drugs include thymosin, oral transfer factor, Bacillus Calmette-Gurin (BCG) vaccine, mannan peptide tablet, polyvalent bacterial vaccine and Chinese herbal medications (Tiaojining and Huangqui granules). […] Several vaccination programs including pneumococcal, influenza A, varicella and measles have been effective in the prevention of infections in nephrotic children. […] However, established measures for preventing infections in nephrotic children are lacking, and to draw any conclusion, randomized controlled trials are required.

• #4 Nephrotic Syndrome: In Children, Treatment, and Causes

  https://www.healthline.com/health/nephrotic-syndrome

  Both primary and secondary nephrotic syndrome can occur in children. Primary nephrotic syndrome is the most common type in children. […] Kids with childhood nephrotic syndrome get more infections than usual. This is because the proteins that normally protect them from infection are lost in their urine. They may also have high blood cholesterol. […] Your doctor may also want to take steps to reduce your risk of infection. To do this, they may recommend that you get a pneumococcal vaccine and yearly flu shot.

• #5 Nephrotic Syndrome in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/n/nephrotic-syndrome-in-children.html

  You can help your child stay healthy in these ways: […] Help prevent your child from having contact with people who have colds or other respiratory illness. A viral respiratory illness could cause a relapse. […] Test your child’s urine for protein every day. This will help to find the early signs of a relapse. […] Postpone routine vaccines until your child is in remission and off steroids for at least 3 months. Talk with your child’s healthcare provider.

• #6

  https://www.kidneyeducation.com/English/nephrotic-syndrome/22

  Most important cause of recurrent swelling in children is nephrotic syndrome. […] Infection is an important cause of recurrence of nephrotic syndrome, so it is essential to protect children against infection. […] To prevent infection, the family and child should be trained to drink clean water, wash hands thoroughly and avoid crowded areas or contact with infectious patients. […] Routine immunization is advised when steroid course is completed. […] As nephrotic syndrome lasts for years, regular urine tests and follow up with the doctor are crucial. […] The infection should be treated adequately before initiating steroid therapy in case of nephrotic syndrome. […] Nephrotic syndrome is a disease that lasts for several years. The patient and his/her family should be educated about the nature of the disease and its outcome; type of medication used and its side effects; and benefits of prevention and early treatment of the infection.

• #7

  https://link.springer.com/article/10.1007/s00467-015-3241-0

  It has been estimated that approximately 110 children with INS would need to be treated for 1 year to prevent one episode of pneumococcal infection. […] The criteria for use of prophylactic antibiotics in children with INS have traditionally been an active area of debate. […] However, the topic has become less relevant following the introduction of universal pneumococcal vaccination. […] The AAP recommends the administration of pneumococcal vaccines to children with INS (if not already immunised). […] The IAP recommends two to four doses of the conjugate pneumococcal vaccine for children aged 2 years. […] For previously unimmunised children aged 2-5 years, a priming dose of the conjugate vaccine is recommended, followed 8 weeks later by a dose of PPSV23. […] Children older than 5 years require only a single dose of the polysaccharide vaccine.

• #8

  https://link.springer.com/article/10.1007/s00467-015-3241-0

  Revaccination after 5 years is considered for children under 10 years old with active INS. […] The AAP recommends annual seasonal administration of influenza vaccine to children with INS. […] The AAP recommends varicella vaccination for non-immune children with INS, post-exposure immunoglobulin for non-immune immunocompromised children and the consideration of intravenous acyclovir for immunocompromised children at the onset of varicella skin lesions.

• #9 Steroid-sensitive nephrotic syndrome in children: triggers of relapse and evolving hypotheses on pathogenesis | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-015-0123-9

  Nephrotic syndrome remains the most common manifestation of glomerular disease in childhood. […] Acute respiratory infections and urinary tract infections are the most frequent infectious triggers of relapse. Targeted interventions like initiating corticosteroid or its dose-adjustment during episodes of acute respiratory infection and zinc supplementation are reportedly effective in reducing relapse rates. […] Interestingly, the recent KDIGO Summary of Recommendation statements in the clinical practice Guideline for Glomerulonephritis advises that daily prednisolone be given during episodes of upper respiratory tract and other infections to reduce the risk for relapse in children with frequently relapsing and steroid dependent SSNS already on alternate day prednisolone. […] Identification of triggers of relapse in SSNS has led to targeted interventions which aim to ameliorate disease morbidity.

• #10 Steroid-sensitive nephrotic syndrome in children: triggers of relapse and evolving hypotheses on pathogenesis | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-015-0123-9

  Nevertheless, prospective interventional studies indicate that relapses are significantly reduced when the maintenance doses of corticosteroids are increased at the onset of viral upper respiratory infections, or when daily corticosteroids are given during onset of viral upper respiratory infections. […] To underscore the importance of respiratory infections as triggers of relapse, zinc supplementation has also been found to reduce relapses in children with SSNS. […] Zinc supplementation is another interventional measure noted to reduce relapse rates in patients with SSNS; reported in two randomized controlled trials. […] For pediatricians and pediatric nephrologists, there is a strong evidence to institute relapse-specific interventions in children with SSNS. […] The KDIGO recommendation of prescribing daily prednisolone during episodes of upper respiratory infections remains a relevant intervention aimed to reduce the risk of relapse. In tandem with this recommendation is the use of zinc supplements which reduces both the frequency of respiratory tract infections and relapse rates.

• #11 Nephrotic Syndrome in Children | National Kidney Foundation

  https://www.kidney.org/kidney-topics/nephrotic-syndrome-children

  Nephrotic syndrome in kids causes swelling and protein loss in urine. Managed with meds and a low-sodium diet. Monitoring is crucial for treatment. […] A low salt (sodium) diet to help limit the swelling in the body is often recommended for children with nephrotic syndrome. This is most important when there is protein leaking into the urine. A dietitian who works with the kidney doctor can provide recommendations.

• #12

  https://www.healthychildren.org/English/health-issues/conditions/genitourinary-tract/Pages/nephrotic-syndrome-in-children.aspx

  A low salt (sodium) diet to help limit the swelling in the body is often recommended for children with nephrotic syndrome. […] This is most important when there is protein leaking into the urine. A dietitian who works with the kidney doctor can provide recommendations.

• #13 Nephrotic Syndrome in Children

  https://healthlibrary.tidelandshealth.org/Conditions/Pregnancy/Tools/90,P03098

  Help prevent your child from having contact with people who have colds or other respiratory illness. A viral respiratory illness could cause a relapse. […] Test your child’s urine for protein every day. This will help to find the early signs of a relapse. […] Postpone routine vaccines until your child is in remission and off steroids for at least 3 months. Talk with your child’s healthcare provider. […] The diet for a child with nephrotic syndrome may include limiting salt and fluids. This may help to regulate your child’s fluid balance. […] Your child’s healthcare provider will talk with you about how much salt and fluids your child should have each day.

• #14 Nephrotic Syndrome in Children

  http://healthlibrary.umcno.org/BreatheEasy/90,P03098

  Nephrotic syndrome is a problem where too much protein called albumin is released from the body into the urine. It means that one or both kidneys are damaged. […] The diet for a child with nephrotic syndrome may include limiting salt and fluids. […] Help prevent your child from having contact with people who have colds or other respiratory illness. A viral respiratory illness could cause a relapse. […] Test your child’s urine for protein every day. This will help to find the early signs of a relapse. […] Postpone routine vaccines until your child is in remission and off steroids for at least 3 months. Talk with your child’s healthcare provider.

• #15 Interventions for preventing infection in nephrotic syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6485906/

  IVIG, thymosin, oral transfer factor, BCG vaccine injection, Huangqi granules and TIAOJINING may have positive effects on the prevention of nosocomial or unspecified infection with no obvious serious adverse events in children with nephrotic syndrome. […] However the methodological quality of all studies was poor, the sample sizes small, and all studies were from China, and thus there is no strong evidence on the effectiveness of these interventions. […] Currently there is no strong evidence for recommending any interventions for preventing infections in nephrotic syndrome. More research is needed. […] No studies were identified that used chemoprophylaxis, pneumococcal vaccination, varicella vaccine or any other nonpharmacological interventions for reducing the risk of infection in children or adults with nephrotic syndrome. […] No RCTs were identified in adults with nephrotic syndrome.

• #16

  https://link.springer.com/article/10.1007/s00467-015-3241-0

  Currently, it is not standard practice to routinely administer antibiotic prophylaxis in relapse or remission of INS. […] The AAP states that there are no data supporting the efficacy of prophylactic penicillin in preventing peritonitis in INS. […] However, some centres, including the Royal Manchester Childrens Hospital (UK) routinely prescribe penicillin prophylaxis (phenoxymethylpenicillin/penicillin V 12.5 mg/kg twice daily) during relapse and stop antibiotic therapy when oedema has abated. […] The reason for the marked variation in clinical practice may be explained by the lack of data: no randomised controlled trial (RCT) has ever been performed to test the efficacy of antibiotic prophylaxis in INS. […] However, the existing data bring into question the efficacy of penicillin V in paediatric INS.

• #17 No strong evidence for any interventions for preventing infection in nephrotic syndrome | Cochrane

  https://www.cochrane.org/CD003964/RENAL_no-strong-evidence-for-any-interventions-for-preventing-infection-in-nephrotic-syndrome

  No strong evidence for any interventions for preventing infection in nephrotic syndrome. […] Currently there is no strong evidence for recommending any interventions for preventing infections in nephrotic syndrome. […] IVIG, thymosin, oral transfer factor, BCG vaccine, Huangqi granules and TIAOJINING may have positive effects on the prevention of nosocomial or unspecified infection with no obvious serious adverse events in children with nephrotic syndrome. […] Many different prophylactic interventions have been used or recommended for reducing the risks of infection in nephrotic syndrome in clinical practice. […] Whether the existing evidence is scientifically rigorous and which prophylactic intervention can be recommended for routine use based on the current evidence is still unknown.

• #18 The Italian Society for Pediatric Nephrology (SINePe) consensus document on the management of nephrotic syndrome in children: Part I – Diagnosis and treatment of the first episode and the first relapse | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-017-0356-x

  We suggest that, once discharged, patients should perform urine dipstick tests: […] We suggest that rapid diagnosis and antibiotic treatment of infections are the most effective interventions. […] We do not recommend administering either i.v. immunoglobulin or prophylactic antibiotics to children. […] We suggest that mild edema be managed with salt and fluid restriction only. […] We suggest that moderate edema be treated with a loop diuretic, with the addition of a potassium-sparing diuretic in the case of prolonged therapy. […] We suggest the co-administration of a thiazide diuretic in cases of severe edema unresponsive to oral or i.v. loop diuretics. […] We suggest albumin infusions in patients with severe edema unresponsive to oral or i.v. loop diuretics. […] We do not suggest thrombophilia screening in children with INS at presentation unless there is a family history of thrombotic events at a young age (50 years) or known abnormalities of pro-thrombotic coagulation factors.

• #19 The Italian Society for Pediatric Nephrology (SINePe) consensus document on the management of nephrotic syndrome in children: Part I – Diagnosis and treatment of the first episode and the first relapse | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-017-0356-x

  There are no indications for anticoagulant/antiplatelet prophylaxis in children with INS at presentation. […] We suggest the use of anticoagulant/antiplatelet prophylaxis in children with a concomitant cardiovascular abnormality (who would usually already be under prophylactic anticoagulant/antiplatelet treatment) or a central venous catheter (CVC) (almost impossible at the onset of illness). […] We do not recommend the routine use of prophylactic PPIs in combination with steroid therapy in NS. […] We do not recommend the use of lipid-lowering treatments at INS onset. […] We do not suggest calcium and vitamin D supplementation in children at first episode or in SSNS unless vitamin D deficiency has been predicted or demonstrated.

• #20 Nephrotic Syndrome – Kidney and Urinary Tract Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/kidney-filtering-disorders/nephrotic-syndrome

  Use of an angiotensin-converting enzyme (ACE) inhibitor, such as enalapril, benazepril, or lisinopril, or an angiotensin II receptor blocker (ARB), such as candesartan, losartan, or valsartan, is the mainstay of both prevention and treatment. […] When a person with a disease such as systemic lupus erythematosus or diabetes mellitus has mild or moderate proteinuria, an ACE inhibitor or ARB is used as soon as possible because the medication may prevent proteinuria from increasing and kidney function from worsening.

• #21 Nephrotic Syndrome In Children: Symptoms, Diagnosis & Treatment | National Kidney Foundation

  https://www.kidney.org/kidney-topics/childhood-nephrotic-syndrome

  Much of your child’s care will be provided by you. Pay attention to your child’s health, but do not overprotect your child. Your child needs to continue his or her usual activities, such as attending school and seeing friends. You should continue to treat your child like all other children in the family. […] If your child is ill or taking prednisone, the doctor will recommend a low salt diet, which will minimize swelling. Your child will be allowed to drink as much he or she wants, however. The first sign that your child is getting sick again is the return of protein in the urine. Because of this, many doctors will ask that you check your child’s urine regularly. […] To prevent further attacks, the primary task of the caregiver is to control the accumulation of fluid in the child’s body with prednisone and diuretics.

• #22 Nephrotic Syndrome in Children

  https://healthlibrary.ecuhealth.org/Library/PreventionGuidelines/90,P03098

  Nephrotic syndrome can get better on its own and with treatment. It may also get worse despite treatment. A child may have periods of improvement and relapses. Family support is important for a child’s well-being. […] Help prevent your child from having contact with people who have colds or other respiratory illness. A viral respiratory illness could cause a relapse. […] Test your child’s urine for protein every day. This will help to find the early signs of a relapse. […] Postpone routine vaccines until your child is in remission and off steroids for at least 3 months. Talk with your child’s healthcare provider.

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