A Child With Nephrotic Syndrome and Abdominal Pain

Acute abdominal pain and nephrotic syndrome: pediatric case reports and review of the literature

“…The most common type of intussusception is ileocolic, and the majority of pediatric cases occur in patients < 1 year of age. Intussusception has also been described as a rare but serious complication of NS and may present atypically unusual location (small bowel), absence of a palpable mass due to ascites, older age at presentation, and absence of the classic triad of symptoms [15]. The most popular hypothesis is that a combination of patchy bowel wall edema and peristaltic incoordination could provide the "pivot (lead point) and torque" in patients with NS [16,17].…”

“…Furthermore, the intussusception interested the small bowel; Doi et al first considered small bowel intussusception to be nonischemic and, therefore, benign and susceptible to spontaneous reduction [19]. Supported by the literature [15,17,[19][20][21], we decided to adopt a conservative approach that led to a spontaneous reduction of intussusception. To our knowledge, this is one of the few pediatric cases of spontaneous resolution of intussusception in NS [15,17].…”

“…Supported by the literature [15,17,[19][20][21], we decided to adopt a conservative approach that led to a spontaneous reduction of intussusception. To our knowledge, this is one of the few pediatric cases of spontaneous resolution of intussusception in NS [15,17]. The association between intussusception and NS was first reported in 1975 [22].…”

“…The association between intussusception and NS was first reported in 1975 [22]. Subsequently, in the following 45 years, only 11 case reports have been described in the literature [15,17,18,[20][21][22][23][24][25][26]. Characteristics of these patients are summarized in Table 3.…”

First episode of nephrotic syndrome with acute abdominal pain

“…The child was diagnosed to have nephrotic syndrome by history of generalized edema with supporting laboratory findings of proteinuria, hypoalbuminemia, and hypercholesterolemia. The possible etiologies of pain abdomen in children with nephrotic syndrome include severe hypovolemia leading to mesenteric ischemia [ 1 ], pain due to distension as a result of massive ascites, spontaneous bacterial peritonitis (SBP), gastroenteritis, UTI [ 1 ], adverse effect of corticosteroids leading to gastritis, mesenteric ischemia due to thromboembolism [ 2 - 4 ], acute appendicitis, intussusception due to severe gut wall oedema [ 5 - 7 ] and rarely even pancreatitis or retroperitoneal abscesses. Our patient had a striking history of high-grade fever, pain abdomen, flexed position of left hip, and pain exacerbating with attempted extension of the left hip (psoas sign).…”