儿童肾病综合征水肿的管理

Management of edema in children with nephrotic syndrome

水肿是肾病综合征的一个主要临床表现,也是多数患儿就诊的主诉。水肿不仅显著影响患儿生活质量,严重时也可出现多种合并症,如处理不当可危及生命。对于糖皮质激素敏感的肾病综合征患儿,仅应用糖皮质激素治疗使原发病获得缓解后,水肿即可完全消退。但对于许多难治性激素耐药肾病综合征或遗传性肾病综合征患儿,针对水肿的对症治疗至关重要。多种机制参与了肾病综合征患儿水肿的发生,针对其机制采取更有针对性的治疗可能会取得更好的疗效并避免药物不良反应。

Edema is one of the main clinical manifestations of nephrotic syndrome(NS),and also the chief complaint to visit a doctor.The condition significantly affects the quality of life in children with NS,and can cause a variety of comorbidities in severe cases,which can be life-threatening without handling properly.For children with steroid-sensitive NS,the edema can be completely resolved after the glucocorticoid therapy.Whereas for many children with steroid-resistant NS or hereditary NS,symptomatic treatment for edema is essential.A variety of mechanisms are involved in the occurrence of edema in children with NS,and more targeted treatments based on the mechanisms may achieve better curative effects and avoid drug side effects.