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Although nephrotic crisis, i.e. acute hypovolemia in the course of nephrotic syndrome, is not uncommon in children, this complication is seldom mentioned in literature. We report a 4-year old boy with a relapse of steroid-sensitive nephrotic syndrome precipitated by a viral respiratory infection, who presented with abdominal pain, vomiting, diarrhea and hypovolemic shock 15 hours after the initial hospital visit. Serum albumin had decreased from 1.5 to 0.6 g/dL, hemoglobin had risen from 16.1 to 19.5 g/dL and urine albumin concentration was 6.5 g/dL. He responded promptly to fluid resuscitation with normal saline and albumin infusion. A bacterial infection was excluded and a diagnosis of nephrotic crisis made based on the combination of a rapid drop in serum albumin and hemoconcentration. Acute loss of the colloid-osmotic pressure gradient at the capillary level caused fluid leakage into the interstitium. Together with fluid losses from intestinal ischemia, this led to acute hypovolemia.
This article was published in the following journal.
Name: Clinical pediatrics
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