Arterial thrombosis is relatively rare compared with venous thrombosis in nephrotic syndrome. However, the assessment of its pathogenesis and risk factors in individual patient with nephrotic syndrome is necessary to allow appropriate prophylactic management because it is a potentially serious problem. Hereby, with review of the literature, we report a case of a 53 yr-old man with cerebral infarction associated with nephrotic syndrome due to focal segmental glomerulosclerosis during the course of treatments with diuretics and steroid. It reveals that the hypercoagulable state in nephrotic syndrome can be associated with cerebral infarction in adults. Prophylactic anticoagulants can be considered to reduce the risk of serious cerebral infarction in nephrotic patients with risk factors such as severe hypoalbuminemia and on diuretics or steroid treatment, even in young patients regardless of types of underlying glomerular diseases.
Cerebral Infarction/epidemiology/*etiology/pathology ; Human ; Male ; Middle Aged ; Nephrotic Syndrome/*complications/epidemiology ; Risk Factors

OBJECTIVETo explore the influence factors on infectious complications in the patients with primary nephrotic syndrome in the course of using glucocorticoid and immune inhibitors.

METHODS571 hospitalized and some outpatients with primary nephrotic syndrome were retrospectively analysed from January,1992 to June,2001 to explore the relationship between the infectious complication and the dose of glucocorticoid,or the curative course of glucocorticoid, or whether glucocorticoid was united with other immune inhibitors,or the course of disease.

RESULTSThe infectious incidence increased gradually and the degree became more serious along with the increase of the glucocorticoid dose and the prolonging of the curative course. To the patients who failed in the treatment of prednisone(dose > or = 1 mg/(kg.d), curative course 1 month or so), the dose of the prednisone was reduced to 0.5 mg/(kg.d) or so and multiglycosides tripterygii wilfordii tablets or cyclophosphamide united. The infectious complications was decreased and the degree was alleviated obviously for the patients treated with this method for more than 2 months compared with those who only used prednisone(dose > or = 1 mg/(kg.d), curative course >3 month). There was no obvious difference in the infectious incidence among the groups of different course of disease before using glucocorticoid.

CONCLUSIONGlucocorticoid and immune inhibitors must be reasonably applied in order to reduce and alleviate infectious complications for treating primary nephrotic syndromes.

Adolescent ; Adult ; Aged ; Child ; Cyclophosphamide ; adverse effects ; Dose-Response Relationship, Drug ; Female ; Humans ; Incidence ; Infection ; epidemiology ; etiology ; Male ; Middle Aged ; Nephrotic Syndrome ; complications ; drug therapy ; Prednisone ; adverse effects ; Retrospective Studies

OBJECTIVETo investigate the spectrum and drug sensitivity of pathogenic bacteria in children with nephrotic syndrome (NS) complicated by urinary tract infection (UTI).

METHODSA retrospective analysis was performed on the spectrum and drug sensitivity of pathogenic bacteria in 97 children with NS complicated by UTI, who hospitalized from January to December, 2011.

RESULTSThe incidence of UTI in children with NS was 36.5%. It was significantly more common in children with recurrent NS than in those with primary NS (44.0% vs 31.9%; P<0.05). These cases mainly presented with asymptomatic bacteriuria. Enterococcus was the most common pathogenic bacteria (50.5%), including Enterococcus faecium (29.4%) and Enterococcus faecalis (21.1%), followed by Gram-negative bacteria, such as Escherichia coli (15.6%) and Klebsiella pneumoniae (14.7%). Enterococcus was highly sensitive to nitrofurantoin, vacomycin and linezolid, but was highly resistant to tetracycline and moxifloxacin. More multi-resistant strains were detected in Enterococcus faecium than in Enterococcus faecalis (72% vs 17%; P<0.05). Escherichia coli and Klebsiella pneumoniae were highly sensitive to amikacin, imipenem and piperacillin/tazobactam. Of the Gram-negative bacteria, 25% produced extended spectrum β-lactamases (ESBLs). ESBLs-producing bacteria had 100% sensitivity to imipenem, amikacin and piperacillin/tazobactam but were highly resistant to ampicillin, cefazolin and ceftriaxone.

CONCLUSIONSChildren with recurrent NS are more susceptible to UTI than those with primary NS. Enterococcus is becoming major pathogenic bacteria for UTI in children with NS and has relatively high drug resistance, and most strains of Enterococcus faecium are multi-resistant.

Adolescent ; Bacteria ; drug effects ; isolation & purification ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Female ; Humans ; Infant ; Male ; Microbial Sensitivity Tests ; Nephrotic Syndrome ; complications ; microbiology ; Recurrence ; Retrospective Studies ; Urinary Tract Infections ; epidemiology ; etiology