Meningitis and intracranial bleed in a child with steroid-resistant nephrotic syndrome

Kapoor, Kamal K.; Saha, Abhijeet; Thakkar, Dhwanee; Dubey, Nand Kishore; Vani, Kavita

doi:10.4103/1319-2442.168668

Cited by 4 publications

(6 citation statements)

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“…In the present study, in a population of 10 461 NS patients, only 15 (0.14%) patients were identified as NS with cerebral hemorrhage, reflecting a low incidence rate. It has previously been reported that cerebral hemorrhage can occur in NS patients without conventional stroke risk factors [3,4]. Similarly, in the present study, 7 NS patients who had no conventional vascular risk factor records developed cerebral hemorrhage.…”

Section: Discussionsupporting

confidence: 80%

“…Cerebral hemorrhage lesions are mainly located in the lobes and subcortical regions [19]. In previous studies, hemorrhage lesions were located at the occipital lobe in many cerebral hemorrhage patients who had NS [3,4,6,20]. Some researchers have speculated that the occipital lobe hemorrhage may have resulted from small blood vessel damage caused by the deposition of immune substances [20].…”

Section: Discussionmentioning

confidence: 99%

“…According to previous publications [3–6], NS patients with cerebral hemorrhage have particular clinical features, such as low plasma albumin, proteinuria, and hyperlipidemia, when compared to traditional cerebral hemorrhage patients. In the present study, all NS patients with cerebral hemorrhage had hypoalbuminemia and proteinuria, and most of them had coagulopathy, elevated D-dimer levels, hyperlipidemia, and renal function impairment.…”

Section: Discussionmentioning

confidence: 99%

“…There is an increased risk of cardiovascular disease in NS patients due to hyperlipidemia, hypertension, and other multifactorial disorders [2]. In recent years, cerebral hemorrhage has been increasingly reported in NS patients [3–6]. It is noteworthy that in some cases, although no conventional vascular risk factor has been recorded, cerebral hemorrhage occurred months after the diagnosis of NS [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, cerebral hemorrhage has been increasingly reported in NS patients [3–6]. It is noteworthy that in some cases, although no conventional vascular risk factor has been recorded, cerebral hemorrhage occurred months after the diagnosis of NS [3,4]. This indicates that NS itself can directly or indirectly affect the onset of cerebral hemorrhage (i.e., NS with cerebral hemorrhage).…”

Section: Introductionmentioning

confidence: 99%

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Clinical Features of Nephrotic Syndrome with Cerebral Hemorrhage

et al. 2019

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Background Cerebral hemorrhage has been increasingly reported in patients with nephrotic syndrome (NS). However, the clinical features and pathogenesis of NS patients with cerebral hemorrhage remain unclear. Material/Methods From January 2007 to August 2017, continuous NS patients with cerebral hemorrhage at the First Affiliated Hospital of Guangxi Medical University were selected. The clinical manifestations, laboratory measurements, and neurological images of these patients were collected and analyzed. Results Acute cerebral hemorrhage was recorded in 15 of 10 461 NS patients. The average age of these 15 patients (9 males and 6 females) was 50.87±23.27 years old. Among these 15 patients, conventional vascular risk factors were identified in 8 patients, hypoalbuminemia and proteinuria were recorded in all 15 patients, coagulopathy was observed in 9 patients, increased D-dimer level was recorded in 13 patients, hyperlipidemia was recorded in 11 patients, and impaired renal function was recorded in 9 patients. The hemorrhage developed in the lobe ( n =9), basal ganglia ( n =3), cerebellum ( n =2), and cerebral hemisphere ( n =1). Eight patients were in a coma on the day the cerebral hemorrhage occurred, while 12 patients had a poor prognosis after 30 days of hemorrhage onset. Conclusions Poor prognosis was recorded in NS patients with cerebral hemorrhage. Although conventional vascular risk factors have only been identified in 8 patients, biochemical abnormalities (hypoalbuminemia, proteinuria, elevated D-dimer, and hyperlipidemia) were recorded in the majority of these 15 patients. Furthermore, most of the hemorrhages developed in the lobes. Coagulopathy might be the potential pathogenesis of cerebral hemorrhage in NS patients.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Features of Nephrotic Syndrome with Cerebral Hemorrhage

et al. 2019

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Characteristics of ischemic stroke and intracranial hemorrhage in patients with nephrotic syndrome

et al. 2021

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Background The incidence of cerebral stroke, including ischemic infarction and intracranial hemorrhage (ICH), increases in patients with nephrotic syndrome (NS). However, the clinical characteristics of patients with NS and stroke remain elusive. We aimed to investigate the clinical presentation and prognosis among patients with NS and ischemic stroke (IS) or ICH. Methods We conducted a population-based retrospective cohort study of patients with NS and acute stroke using the Chang Gung Research Database of Taiwan from January 1, 2001, to December 31, 2017. The participants were recruited from the 7 branches of Chang Gung Memorial Hospital. Results A total of 233 patients with IS and 57 patients with ICH were enrolled. The median age was 60 (52–70) years. The prevalence rates of hyperlipidemia, hyperuricemia, and smoking were higher in IS than in ICH. IS demonstrated lower white blood cell count (7.80 vs. 8.92 × 109/L) and high-sensitivity C-reactive protein level (33.42 vs. 144.10 nmol/L) and higher cholesterol (5.74 vs. 4.84 mmol/L), triglyceride (1.60 vs. 1.28 mmol/L), and albumin (24 vs. 18 g/L) levels compared with ICH. The dependent functional status and 30-day mortality were higher in ICH than in IS. The risk factors for 30-day mortality for patients with NS and stroke were coronary artery disease (CAD), ICH, and total anterior circulation syndrome. The multivariate Cox regression analysis revealed that CAD was positively associated with 30-day mortality in patients with IS (hazard ratio 24.58, 95 % CI 1.48 to 408.90). In patients with ICH, CAD and subarachnoid hemorrhage were positively associated with 30-day mortality (hazard ratio 5.49, 95 % CI 1.54 to 19.56; hazard ratio 6.32, 95 % CI 1.57 to 25.53, respectively). Conclusions ICH demonstrated a higher risk of dependence and 30-day mortality compared with IS in patients with NS. Intensive monitoring and treatment should be applied particularly in patients with NS and ICH.

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Streptococcus pneumoniae meningitis in a child with idiopathic nephrotic syndrome: a case report

et al. 2022

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Background Children with nephrotic syndrome are at increased risk of infections, including bacterial peritonitis, pneumonia, and cellulitis. However, bacterial meningitis, a potentially life-threatening complication, has not been highlighted as an infectious complication of nephrotic syndrome in recent reviews. We report a very subtle and unusual presentation of bacterial meningitis in a child with nephrotic syndrome, which without a high index of suspicion, would have been missed. Case presentation A 9-year-old African-American male with a history of steroid-dependent nephrotic syndrome presented to the nephrology clinic for routine follow-up. His medications included mycophenolate mofetil and alternate-day steroids. His only complaint was neck pain and stiffness that the mother attributed to muscle tightness relieved by massage. There was no history of fever, vomiting, headache, photophobia, or altered mental status. On physical examination, he was afebrile (99 °F), but had mild periorbital swelling and edema on lower extremities. He appeared ill and exhibited neck rigidity, and demonstrated reflex knee flexion when the neck was bent. Laboratory evaluation revealed leukocytosis, elevated C-reactive protein, hypoalbuminemia, and proteinuria. Cerebrospinal fluid suggested bacterial meningitis. The patient was treated with ceftriaxone and vancomycin. Both cerebrospinal and blood cultures grew Streptococcus pneumoniae; vancomycin was discontinued. The child completed a 2-week course of ceftriaxone and was discharged home. Conclusions A high index of suspicion is necessary in children with nephrotic syndrome treated with corticosteroids, as symptoms may be masked, and thus, a life-threatening disease be missed. Bacterial meningitis should be highlighted as a serious infection complication in children with nephrotic syndrome.

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Meningitis and intracranial bleed in a child with steroid-resistant nephrotic syndrome

Cited by 4 publications

References 0 publications

Clinical Features of Nephrotic Syndrome with Cerebral Hemorrhage

Clinical Features of Nephrotic Syndrome with Cerebral Hemorrhage

Characteristics of ischemic stroke and intracranial hemorrhage in patients with nephrotic syndrome

Streptococcus pneumoniae meningitis in a child with idiopathic nephrotic syndrome: a case report

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