Clinical Analysis of Primary Nephrotic Syndrome Complicated by Plastic Bronchitis in Children

Abstract

Objective To summarize the clinical features of primary nephrotic syndrome (PNS) complicated by plastic bronchitis (PB) in children to provide guidance for treatment. Methods We conducted a retrospective review of the clinical data of 25 children hospitalized with NS complicated by PB in our Hospital between 10/2016 and 03/2019, and summarized the clinical manifestations, imaging and fiberoptic bronchoscopy (FOB) examinations, treatment course and outcome of them. Results 1). The 25 children, with a nephrotic syndrome (NS) course of one to 36 months, were all diagnosed with PB after FOB, among which 8 cases (32%) had respiratory failure and required ventilatory support. All of them started with respiratory symptoms such as fever and cough, and then suffered from dyspnea and progressive aggravation after 1–3 day(s) of onset, with rapid occurrence of bidirectional dyspnea and even respiratory failure in severe cases. 2). Laboratory test for pathogens: influenza A virus H1N1 (11 cases), influenza B virus (9 cases), adenovirus (3 cases) and mycoplasma pneumoniae (2 cases). There was no statistically significant difference (P>0.05) between children with common NS complicated by influenza virus (IV) infection (not accompanied by dyspnea) and those with kidney disease who developed PB in the white blood cell count, lymphocyte count, the inflammatory biomarkers C-reactive protein (CRP), procalcitonin (PCT) and humoral immunity (IgG level), yet the total IgG level was found significantly higher and the blood albumin level lower in the latter (P<0.05). 3). The 25 children were all examined with the FOB and treated with lavage, 15 of which had typical bronchial tree-like casts and 10 broken and stringy casts. Based on histopathological classification, all children were of Type I. 4). Twenty children (80%) with influenza were administered the antiviral drug Oseltamivir, 20 (80%) were treated with antibiotics, oral hormones were replaced with the same dosage of intravenous Methylprednisolone for 5 cases (20%), and 20 (80%) were intravenously administered gamma globulins (400–500 mg/kg x 3 days). These children showed a remarkable improvement after treatment and there were no deaths. Conclusion NS children are at high risk of influenza virus infection. Children with a severe case of NS are more susceptible to PB. If symptoms like shortness of breath, wheezing and progressive bidirectional dyspnea occur, FOB examination and lavage treatment should be performed as early as possible. Hyper-IgE-emia and hypoproteinemia may be the high risk factors for PNS complicated by PB in children.

Analysis of Clinical Characteristics and Risk Factors of Plastic Bronchitis in Children With Mycoplasma pneumoniae Pneumonia

“…Its onset is insidious, and its diagnosis is mainly based on bronchoscopy and pathologic examination of plastic foreign bodies. The common diseases of childhood PB are lower respiratory tract infection, cyanotic congenital heart disease, bronchial asthma and respiratory allergic diseases, as well as sickle cell anemia, globin dysplasia anemia, cystic fibrosis, and primary nephrotic syndrome ( 9 , 10 ). In recent years, the clinical manifestations of MPP in children have varied, and the cases of severe MPP and refractory MPP have significantly increased, while few clinical reports of secondary PB have been published ( 11 ).…”

Plastic bronchitis in a child with nephrotic syndrome

“…In a report of pediatric cases of severe influenza A infection, two of the 15 patients had NS, one of whom died after developing PB 4 . In a recent report of 25 children with NS complicated by PB, the influenza virus was the most common pathogen and hyper‐IgE‐emia and hypoproteinemia were risk factors for PB 5 . Our patient also had a markedly high IgE level (16 900 IU/mL) and atopic dermatitis, which could predispose him to bronchial asthma.…”

Plastic Bronchitis in Children: A Review of 55 Cases over a 10‐Year Period

“…Numerous systemic illnesses have been reported to be associated with PB, including Fontan cardiac surgery [ 8 ], asthma [ 9 ], nephrotic syndrome [ 10 ], and idiopathic chronic eosinophilic pneumonia [ 11 ]. About one-third of the children in our study had underlying disorders with scattered profiles, with asthma accounting for the largest proportion.…”