Pancreatic lesion in children with nephrotic syndrome

Abstract

Nephrotic syndrome occupies one of the leading places among kidney diseases in children. Scientific studies indicate that edema syndrome, arterial hypertension, disorders on the microcirculatory level occurring in case of nephrotic syndrome contribute to the slowing and reduction of blood flow in the pancreas, which leads to the development of hypoxia and metabolic disorders. Under conditions of metabolic and microcirculatory disorders, as well as against the background of the therapy used in children with nephrotic syndrome the risk of secondary pancreas lesion increases significantly. Pathogenetic treatment of nephrotic syndrome involves the administration of glucocorticosteroid and cytostatic therapy. The study of autopsy materials of the pancreas in children who died of glomerulonephritis revealed histomorphological changes in 35.7% of children in the form of acute interstitial pancreatitis and pancreonecrosis. At the same time there are still few works in the scientific literature, devoted to the study of functional state of the pancreas in children with kidney diseases. The data on pancreatitis prevalence in children are extremely inconsistent. Significant variation in the frequency of pancreatic lesion in children (from 5 to 25%) is most often associated with diagnostic difficulties. Ultrasound examination after a meal (postprandial test) allows to diagnose pancreatic pathology (indirect signs of chronic pancreatitis, reactive pancreatic changes) with higher accuracy (by 23%) than traditional examination. Late diagnosis of pancreatic lesion and lack of correction can significantly affect patients’ health and quality of life. There is a need to study functional state of pancreas in children with nephrotic syndrome to improve understanding of pathogenesis of possible involvement in pathological process and optimization of preventive and therapeutic tactics.