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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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A condition characterized by severe PROTEINURIA, greater than 3.5 g/day in an average adult. The substantial loss of protein in the urine results in complications such as HYPOPROTEINEMIA; generalized EDEMA; HYPERTENSION; and HYPERLIPIDEMIAS. Diseases associated with nephrotic syndrome generally cause chronic kidney dysfunction.
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A syndrome characterized by retropatellar or peripatellar PAIN resulting from physical and biochemical changes in the patellofemoral joint. The pain is most prominent when ascending or descending stairs, squatting, or sitting with flexed knees. There is a lack of consensus on the etiology and treatment. The syndrome is often confused with (or accompanied by) CHONDROMALACIA PATELLAE, the latter describing a pathological condition of the CARTILAGE and not a syndrome.
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