Bahriye ATMIŞ, Derya CEVİZLİ, Aysun Karabay BAYAZIT

Nefrotik Sendrom Tanılı Çocukların Son Beş Yılda Hastaneye Yatış Endikasyonları ve Prognozları

Amaç: Bu çalışma ile kliniğimizde nefrotik sendrom tanısıyla takip edilen çocuklarda hastaneye yatış nedenlerinin belirlenmesi, klinik özelliklerinin incelenmesi ve prognozlarının değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Çalışmamızda Çukurova Üniversitesi Çocuk Nefroloji Bilim Dalında nefrotik sendrom tanısıyla takip edilen hastaların son beş yıldaki hastaneye yatış nedenleri incelendi. Halen takibimizde olan hastalar ise prognozları açısından değerlendirildi. Bulgular: Çukurova Üniversitesi Tıp Fakültesi Çocuk Nefroloji servisine nefrotik sendrom tanısıyla 2015-2019 yılları arasında toplam 117 çocuk 299 kez yatırıldı. Bu hastaların 58’i (%49.6) kızdı. Hastaların ortalama yatış günü 9.98±16.91 gündü. Hastaların en sık yatış nedenleri ritüksimab infüzyonu (%24.7), böbrek biyopsisi (%22.1), pulse metilprednisolon (%12.7), ağır ödem (%12.4) ve enfeksiyonlardı (%11). Takibe devam eden hastalar prognozları açısından incelendiğinde hastaların %51.5’ü remisyonda iken %17.4’üne evre 5 kronik böbrek hastalığı nedeniyle renal replasman tedavisi (RRT) başlandı. Son takiplerinde RRT yapılan hastaların ortalama hastanede yatış günü 24.4±33.1 gün iken, RRT ihtiyacı olmayan hastalarda 7.9±10.7 gündü (p <0.001). Hastaların hastanede toplam yatış süreleri ile mortalite arasında anlamlı bir ilişki saptanmadı (p = 0.62). NS tanılı hastalarda RRT yapılması ile mortalite arasında anlamlı bir ilişki saptandı (p <0.001). Sonuç: Hastanemiz bölgemizde bir referans hastanesi olduğundan kliniğimizde çok sayıda NS tanılı çocuk hasta takip edilmektedir. Hastanede toplam yatış gün sayısı ile morbiditeye ve mortaliteye neden olan RRT ihtiyacı arasında anlamlı bir ilişkili bulunmuştur. Nefrotik sendromlu çocuk hastaların prognozu çoğunlukla iyi olsa da hayati tehdit edici komplikasyonlar ve mortalite görülebilmektedir.

Anahtar Kelimeler:

hastaneye yatış, çocuk, nefrotik sendrom, prognoz

Causes of Hospitalization and Prognosis of Children with Nephrotic Syndrome in The Last Five Years

Objective: The aim of this study was to determine the causes of hospitalization, to examine the clinical features and to evaluate the prognosis in children with nephrotic syndrome who were followed-up in our department. Material and Methods: In this study, the causes of hospitalization in the last five years of the children with nephrotic syndrome who were followed-up in the Department of Pediatric Nephrology at Cukurova University were examined. The patients who are still under follow-up were evaluated in terms of their prognosis. Results: A total of 117 children were admitted to the Pediatric Nephrology ward 299 times between 2015-2019 with the diagnosis of nephrotic syndrome. Fifty-eight (49.6%) of these patients were girls. The mean hospitalization day of the patients was 9.98±16.91 days. The most common reasons for hospitalization were rituximab infusion (24.7%), kidney biopsy (22.1%), pulse methylprednisolone (12.7%), severe edema (12.4%) and infections (11%). The patients who are still follow-up were examined in terms of their prognosis, 51.5% of the patients were in remission, while kidney replacement therapy (KRT) was initiated in 17.4% due to stage 5 chronic kidney disease. While the mean hospitalization day of the patients who underwent KRT in their last follow-up was 24.4±33.1 days, it was 7.9±10.7 days in patients who did not require KRT (p <0.001). There was no significant relationship between the length of stay in the hospital and mortality (p = 0.62). A significant relationship was found between performing KRT and mortality in children with NS (p <0.001). Conclusion: Since our hospital is a reference hospital in our region, many pediatric patients with NS diagnosis are followed in our department. A significant correlation was found between the total length of stay in hospital and the requiring for KRT, which causes morbidity and mortality. Although the prognosis of children with nephrotic syndrome is usually good, life-threatening complications and mortality can be seen.

Keywords:

nephrotic syndrome, hospitalization, children, prognosis,

PDF

___

The primary nephrotic syndrome in children: Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. A report of the International Study of Kidney Disease in Children. J Pediatr 1981;98:561–4.
Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet 2003;362:629–39.
Rheault MN. Nephrotic syndrome. In Kher KK, Schnaper HW, Greenbaum LA (eds). Clinical Pediatric Nephrology. Third Edition. Boca Raton: CRC press, 2017:285-303.
Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009;20:629-37.
KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 2013;3:1-150.
Niaudet P, Boyer O. Idiopathic Nephrotic Syndrome in Children: Clinical Aspects. In Avner ED, Harmon WE, Niaudet P, Yoshikawa N, Emma F, Goldstein SE (eds). Pediatric Nephrology. 7th edition. Berlin Heidelberg: Springer-Verlag 2016:830-82.
Yılmaz K, Düşünsel R, Dursun İ, Yel S, Gündüz Z, Poyrazoğlu H. Idiopathic Nephrotic Syndrome in Childhood: A Retrospective Analysis of Two Hundred and Eighty Nine Patients. Med Bull Haseki 2017;55:280-5.
Hacıhamdioğlu DÖ, Kalman S, Faysal Gök F. Long-term results of children diagnosed with idiopathic nephrotic syndrome; single center experience. Turk Pediatri Ars 2015;50:37-44.
Internationale Study of Kidney Disease in Children; prediction of histopathology from clinical and laboratory characteristics at time of diagnosis, Kidney Int 1978;13:159-65.
Rheault MN, Zhang L, Selewski DT, Kallash M, Tran CL, Seamon M, et al. AKI in Children Hospitalized with Nephrotic Syndrome. Clin J Am Soc Nephrol. 2015 Dec 7;10(12):2110-8.
Carpenter SL, Goldman J, Sherman AK, Selewski DT, Kallash M, Tran CL, et al. Association of infections and venous thromboembolism in hospitalized children with nephrotic syndrome. Pediatr Nephrol 2019; 34:261–7.
Kumar M, Ghunawat J, Saikia D, Manchanda V. Incidence and risk factors for major infections in hospitalized children with nephrotic syndrome. Braz J Nephrol 2019;41:526–33.
Ajayan P, Krishnamurthy S, Biswal N, Mandal J. Clinical spectrum and predictive risk factors of major infections in hospitalized children with nephrotic syndrome. Indian Pediatr. 2013;50:779-81.
Wei CC, Yu IW, Lin HW, Tsai AC. Occurrence of infection among children with nephrotic syndrome during hospitalizations. Nephrology (Carlton) 2012 ;17:681-8.
Carter SA, Mistry S, Fitzpatrick J, Banh T, Hebert D, Langlois V, et al. Prediction of Short- and Long-Term Outcomes in Childhood Nephrotic Syndrome. Kidney Int Rep 2019;5:426-34.
Trautmann A, Schnaidt S, Lipska-Zietkiewicz BS, Bodria M, Ozaltin F, Emma F, et al. Long-term outcome of steroid-resistant nephrotic syndrome in children. J Am Soc Nephrol 2017;28:3055–65.
Trompeter RS, Lloyd BW, Hicks J, White RH, Cameron JS. Long-term outcome for children with minimal-change nephrotic syndrome. Lancet 1985;1:368–70.
Prasad BS, Kumar M, Dabas A, Mishra K. Profile of Acute Kidney Injury in Hospitalized Children with Idiopathic Nephrotic Syndrome. Indian Pediatr 2019;56:119-22.