Safety And Efficacy Of Blood Purification Therapy For Primary Nephrotic Syndrome In Children

Objective:To evaluate the safety and effects of hemodiafiltration on children with primary nephritic syndrome, and study how to choose the suitable blood purification mode.Method:60 chilren with primary nephrotic syndrome were retrospectively analyzed, who were treated by blood purification and who were admitted between April,2008 to April,2014 in children’s hospital of Chongqing Medical University. According to the clinical data of them, we analyze mode, efficacy,and complication of blood purification.Results:1. From April,2008 to April,2014,60chilren with primary nephrotic syndrome were treated by blood purification.For clinical type,15 cases(25.00%) was simple type and 45 cases(75.00%) was nephritic type. There were 27 cases who underwent renal biopsy, with 9 cases minimal change disease(33.33%) and 18 cases non-minimal change disease (66.67%).2.A total of 233 cases used blood purification in 60 children. According to the blood purification mode, they were divided into three groups, which were hemodialysis (HD), hemodiafiltration (HDF),and hemofiltration (HF).The ages of them were 10.11±3.91 years old, 7.56±4.41 years old and 3.04±1.23 years old respectively(P<0.05), and the serum albumin were 24.84±5.65g/L,22.08±6.54 g/L and 18.64±7.32 g/L respectively(P< 0.05).3.In the process,we used heparin for anticoagulation in 229 cases (98.28%),and we gave albumin or (and) plasma or (and) red blood cell suspension for priming in 144 cases (61.80%)4.Comparing some indicators before and after the blood purification, the urine volume was markedly increased(251.13±285.83ml/d and 355.16±373.71ml/d,P<0.05), and the abdomen circumference was significantly reduced (68.58±10.20cm and 66.89±10.63cm,P<0.05),and the urea nitrogen was notablely reduced (21.56±9.19 mmol/1 and 12.26±5.13 mmol/1,P< 0.05),the creatinine was notablely reduced (291.31±184.78 ummol/1 and 185.52±122.46 ummol/1,P<0.05),and 24 hours urinary protein was significantly improved (2.82±2.51g/L and 0.92±0.88 g/L,P<0.05).5.During the treatment,12 cases of times occured complications, including 5 cases hypertension,4 cases bleeding tendency,3 cases hypovolemic shock, and the rate was 5.15%.Conclusion:1.Children with primary nephrotic syndrome who need to conduct the blood purification adjuvant therapy have follow characters:the main clinical classification is nephritis type, and the main pathological change is non-minimal change.2. We can choose hemofiltration for younger children, and select hemodialysis for elder one with impaired renal function, and choose hemodiafiltration for children with both edema and renal damage obviously.3.After blood purification,the main clinical manifestation including edema and oliguria were improved. In addition, renal function and urine protein were improved.Blood purification technology assisting the treatment of children with primary NS severe edema and/or renal insufficiency is efficacy, low complication, safe and reliable.