What Is the Treatment for Hypercholesterolemia in Children?

Pediatric nephropathy is more common in primary disease. The main lesion is increased glomerular basement membrane permeability. Clinical manifestations are often a large amount of proteinuria, hypoalbuminemia, hypercholesterolemia, marked depression in the body and renal function. A series of symptoms such as abnormalities. During the treatment process, comprehensive measures such as rest, nutrition, maintaining the balance of hydroelectric media, prevention of infection, and diuretic swelling are often used. Among them, hormone therapy is the most important. Commonly used drugs are prednisone.

Chinese name: Pediatric nephropathy

Foreign name: children nephrotic
Subject: Pediatrics

Pediatric kidney disease

Nephrotic syndrome is mainly due to the impaired barrier function of the glomerular filtration membrane, resulting in a large number of proteinuria, hyperlipidemia, edema, and hypoproteinemia as a group of clinical manifestations. Modern medicine believes that pediatric nephrotic syndrome is mainly a humoral immune abnormality of the human body, which causes a variety of pro-inflammatory factors and T cell dysfunction.

Glomerular disease is a common and frequently-occurring disease in childhood, and it is also one of the main causes of irreversible end-stage renal failure. Because there are many types of diseases (up to ten types), it is difficult to classify the diagnosis. If these diseases are collectively referred to as nephritis, the uniform treatment method will not receive good results. The only way to pinpoint the diagnosis of a disease is a kidney biopsy. But because children's organs are small and uncooperative, puncturing is difficult

Kidney Anatomy The degree is large and there are certain risks in operation. Many hospitals have not carried out this project. Professor Wang completed the experimental work at the Nephrology Centre of Royal Melbourne Hospital, Australia. Since 1982, he has led the research team to conduct research on small kidney disease. After more than 20 years of clinical practice, he has explored a set of renal biopsy methods for children. Under the guidance of B-ultrasound, renal puncture biopsy was successfully performed on more than 1,500 children, and 25 tests including renal pathology and immunofluorescence were completed. Combining cases,

An epidemiological analysis was carried out, and the intrinsic relationship between the pathological type, age, gender, distribution characteristics and clinical manifestations of children with glomerular diseases with Chinese characteristics was obtained, which provided a theoretical basis for the accurate diagnosis of glomerular diseases.

Speaking of parents and children's doubts about renal biopsy, Professor Wang said that this test is indeed risky and has high standards for doctors' technical requirements. We have done more than a thousand children, the youngest being 4 months, no A severe complication such as major bleeding, infection, kidney laceration, and mis-penetration of other organs. The operation time is about 10 to 20 minutes. The results of inspection can generally make the diagnosis clear at a glance, and play an important guiding significance for the treatment and prevention of glomerular diseases in children.

Clinical manifestations of pediatric nephropathy

1. Whole body edema. It started to appear in the eyelids and face of children with pediatric nephrotic syndrome, and gradually spread throughout the body. Patients with severe pediatric nephrotic syndrome may have pleural and abdominal effusions, and edema of the scrotum, penis, and labia, most of which are concave.

2. Normal or elevated blood pressure.

3. May have oliguria or hematuria.

Pediatric nephropathy diagnosis basis

1. The whole body is swollen and pitted.

2. A large amount of proteinuria (+++ to ++++) or 24-hour urine protein exceeding 0.1g / kg for more than 2 weeks.

3. Hypoalbuminemia: The total plasma protein is lower than normal, and the albumin decrease is more obvious, often <30g / L. A2 and globulin were relatively elevated.

4. Hypercholesterolemia: Plasma cholesterol is often> 5.7mmol / L (220mg / dl).

Pediatric nephropathy needs examination

1. To confirm the diagnosis, first check the urine routine, plasma protein and blood cholesterol.

2. To identify simple nephrotic syndrome or nephritis nephrotic syndrome, urine routine, ESR, blood urea nitrogen, serum creatinine, serum C3, urine C3, liver function, and hepatitis B virus markers should be checked.

3. In order to prevent infection, mid-section urine culture, plain radiographs of the chest and abdomen, and blood culture are required.

4. Do renal B-ultrasound (especially B-ultrasound), nephrogram, and intravenous pyelography when necessary to understand renal function.

Pediatric nephropathy treatment principles

Unfractionated heparin is a prophylactic anticoagulant, which is inexpensive and widely used in clinical pediatrics.

Nowadays, clinically, drug treatment is preferred for pediatric nephrotic syndrome. Low-molecular-weight heparin mainly refers to a new drug obtained by depolymerization of ordinary heparin. It has the characteristics of convenient administration and long biological half-life, and low-molecular-weight heparin will not interfere with thrombin activity. In recent years, the application of low-molecular-weight heparin in the treatment of nephrotic syndrome has received increasing attention. The mechanism of low molecular weight heparin used in nephrotic syndrome mainly includes the following aspects: (1) anti-aldosterone and anti-inflammatory activity; (2) can improve the barrier effect of the filtration membrane and reduce the excretion of urine protein; (3) can reduce the plasma Viscosity, improve hypercoagulability. Some scholars have found that low molecular treatment of pediatric nephrotic syndrome can significantly improve children's APTT, PT, 24h urine protein, cholesterol and serum albumin, which has good clinical application value.

Pediatric nephropathy

First, children should not be tired. Children have poor self-discipline. They will feel very fresh when they return home from the hospital, and they will be too tired to play. They will not get enough sleep. Parents should pay special attention to arranging their children's rest time and try to get enough rest.

Second, children should not eat more salty food. It is very important to pay attention to less salt in the diet to children who have not lowered their blood pressure to normal. However, salt-free meals can affect appetite, and low-salt diets should be used. After the edema and high blood pressure disappear, the general diet can be improved, but it should be light and not too salty. Steamed bread and soda crackers also contain sodium. It is best not to give them to children. Let your child eat some fresh vegetables and fruits to supplement the body's vitamins.

third. General care:

1. Bed rest is required for severe edema and hypertension at rest. Generally, there is no need to strictly restrict activities, and cultural and recreational activities are appropriately arranged according to the condition to make the child happy.

2, diet to ensure calories, protein intake is controlled at about 2g / kg daily is appropriate. Short-term salt restriction when there is significant edema or hypertension.

3. Skin care Keep the skin clean and dry, avoid abrasions and pressure, and turn over regularly. The bedding should be soft. The hips and limbs can be cushioned with rubber air cushions or cotton pads, and air cushion beds can be used if necessary. The swollen scrotum can be supported by cotton pads or slings, and the ruptured skin should be covered with a disinfectant dressing to prevent infection.

4. Patients with severe edema should try to avoid intramuscular injection of drugs that often cause drug retention, malabsorption or extravasation of the pinhole drug solution after injection due to severe edema, which leads to local wetness, erosion or infection. When intramuscular injection is necessary, pay attention to strict disinfection, and press a little longer after injection to prevent extravasation of the drug solution.

5.Observe changes in edema

6.Prevent infection

7. Observe the efficacy and side effects of the drug

8. Health education

Physiological characteristics of pediatric kidney

After birth, the kidney replaces the placenta and becomes the main organ for maintaining internal environment stability. However, its physiological function is not mature enough, and its reserve function is poor. It usually reaches the human level when it is 1 to 1 and a half years old.

(1) Glomerular filtration rate The neonatal glomerular filtration rate is 1/4 of that of an adult. It is close to the level of an adult at the age of 1, so excess water and solutes cannot be quickly and efficiently discharged.

(2) The function of renal tubular reabsorption and excretion The neonatal renal tubular reabsorption function is poor, so intravenous glucose or oral glucose is prone to urine glucose. The kidneys of newborns and young infants have poor excretion of the drug, so the dose should be careful and cautious when taking the drug. Neonatal renal tubules are more immature than glomeruli, and are therefore prone to edema.

(3) Concentration and dilution function Infants have poor renal concentration function, less urea production and low excretion rate, so infants have less urine solutes and lower urine specific gravity. Its dilution function is relatively good, and it can release urine to a level close to that of adults, but because the glomerular transit rate is low, the rate of draining water is slow. When it is overloaded, it is prone to dehydration, edema or water poisoning. Therefore, attention should be paid when fluid replacement is needed.

Pediatric nephropathy Pediatric acute nephritis diet

How to take care of children with acute nephritis, what foods to eat, what foods to eat, whether to rest in bed, when they can return to school, whether they will relapse, etc. This is a question that parents are very concerned about.

What is acute kidney disease in children ?

In childhood, most of the acute nephritis is caused by certain antigens and antibodies caused by the hemolytic streptococcus enter the human body, causing kidney damage. The main site of kidney disease is the glomerulus. Normal people have one million glomeruli in each of their two kidneys. Almost 80% of the glomeruli are affected in acute nephritis. As a result, urine volume decreases, edema, hematuria, and hypertension occur clinically. In severe cases, the following symptoms can also occur: hypertensive brain with heart failure (or circulatory congestion), acute renal failure (uremia).

Because most of the children can be treated in time and diagnosed in time, the above-mentioned serious life-threatening symptoms are rarer than before. Some patients can be quite mild, with mild eyelid edema, small amounts of protein and red blood cells in the urine.

What to pay attention to in children with kidney disease diet

Abstain from salt

Eat salt at the beginning of acute nephritis. Because the urinary capacity of the kidneys is weakened at this time, if the salt that is eaten cannot be excreted normally, it will accumulate in the body, and water will also be produced. Generally speaking, one gram of salt can stay in 120 milliliters of water, which will increase edema, and the purpose of quitting salt is only for this purpose. It should be noted that salt has no effect on nephritis. Eating salt does not aggravate kidney disease, so when nephritis improves, renal function gradually recovers, and urine output can be lifted. It should be known that long-term abstinence from salt is not only difficult to cook, the food is light and tasteless, but also affects the child's appetite, which leads to malnutrition and even hyponatremia. Can I use salt substitutes, or "alkali autumn stones" during salt abstinence? Answer: The salt substitute or "alkali autumn stone" is actually potassium chloride. In the early stage of acute nephritis, when there is renal insufficiency, there is often hyperkalemia. The consumption of salt substitute and alkali autumn stone is undoubtedly a fuel for the fire. Aggravating hyperkalemia, a slight inadvertent risk of lethality. Of course, it's okay to eat during the diuretic and recovery periods. In fact, this kind of salt tastes strange and unpalatable, and most children are unwilling to eat it.

Protein

At the onset of acute nephritis, there are many kidney dysfunctions, and the metabolic waste of the protein that is eaten must be excreted by the kidneys. Therefore, it is not appropriate to eat too much protein-containing foods, including meat, eggs and plants with higher protein Beans, etc., eating more will increase the accumulation of metabolic waste in the blood, that is, azotemia. However, there is no need to abstain from protein for a long time. As long as renal function improves, diuretic swelling occurs clinically, and blood urea nitrogen (BUN) returns to normal in the blood test, a normal diet can be used. Folklore 100-day abstinence is unfounded. In acute nephritis, protein does not damage the kidney. On the contrary, some amino acids derived from the protein are needed for the kidney to recover. Long-term low protein is not good for children's growth and development. Mild acute nephritis can be done without restricting protein intake. If the patient has a large amount of proteinuria, the protein intake should be reduced.

Water restrictions

Generally nephritis does not need to restrict drinking water. Most patients with edema will not be thirsty and do not need to drink too much water. Patients with severe edema and small urine volume should limit water; patients with acute renal failure should limit water strictly. If there is no need, do not drip the fluid intravenously. In order to reduce the amount of water, even the traditional Chinese medicine should be limited. Because in this case, like a child weighing 25 kg (approximately 7 to 8 years old), the amount of water (including drinking, intravenous drip, etc.) that enters the body every day cannot exceed 400 ml plus the urine volume of the day. A bowl of Chinese medicine has taken up more than half of this limit, limiting the amount of other fluids that need to be replenished. Never think that urinating less is not enough water, and use drinking water to diuretic.

fruit

In general, acute nephritis is not necessary to quit fruit, but it is not recommended to eat too much fruit, especially for patients with severe illness. This is due to poor kidney function and limited potassium excretion capacity. Fruits are quite rich in potassium, which will increase blood potassium if you eat too much. If hyperkalemia already exists, it is very dangerous. Patients with renal failure and hyperkalemia must abstain from fruits and other high potassium foods, such as sweet potatoes, potatoes, bamboo shoots, shiitake mushrooms, cabbage, mustard, beans, peanuts and walnuts. In the recovery period, eating fruits will help patients recover.

Pediatric nephropathy Principles of diet and nutrition in children with nephropathy

1. Low-protein diet: The protein supply depends on the condition to reduce the burden on the kidneys. Low protein diet should not be too long to prevent anemia.

2. Limit sodium and water: To eliminate edema, limit sodium and water. According to the condition, urine output and edema, a low-salt, no-salt or low-sodium diet should be given.

3. Avoid eating foods high in potassium such as mushrooms, shiitake mushrooms, red dates, shellfish, beans, vegetables and fruits.

4. Enough carbohydrates and fats: Dietary calories are mostly provided by carbohydrates. Add enough carbohydrates to prevent insufficient heat.

5, the appropriate amount of heat energy supply: severe children need bed rest, reduce heat energy consumption, reduced activity can reduce appetite, so the daily supply of heat energy does not have to be too high.

Pediatric nephropathy

Pediatric disease is extremely susceptible to urinary system disease-nephrotic syndrome. Although the etiology of this disease is not very clear, it is often divided into three types: primary, secondary, and congenital nephropathy. Its main features are high edema, hypercholesterolemia, a large amount of proteinuria, and low protein blood. disease. In terms of treatment, most parents and doctors only pay attention to treatment with appropriate rest, reasonable diet, prevention of infections, diuretic swelling, and application of adrenocortical hormones and immunosuppressive agents, while negligent to supplement children with vitamin D and calcium As a result, hypocalcic convulsions, tetany of hands and feet, or osteoporosis occur from time to time in the clinic, so people should pay enough attention to it.

Generally, children with nephrotic syndrome have large amounts of proteinuria. At the same time that a large amount of protein is lost, calcium that is easily bound to albumin in the blood is also excreted with proteinuria. At this time, the child is in the stage of vigorous growth and development, and the body's demand for calcium is relatively increased. Therefore, too much proteinuria causes more calcium loss, which is likely to cause calcium deficiency in children. If you do not pay attention to timely calcium supplementation or inadequate intake of calcium-containing foods, it will eventually lead to low blood calcium, induce hypocalcemic convulsions, hand and foot convulsions. In addition, the treatment of nephrotic syndrome requires long-term use of large doses of corticosteroids. Pharmacological studies have shown that hormones have the effect of counteracting the absorption of vitamin D and calcium from the human intestinal wall. This makes the calcium deficiency in children more severe, which can easily lead to osteoporosis in children, and prone to fractures. Calcium edge tablets contain calcium carbonate (the highest content), vitamin D (the body's carrier for calcium ion absorption), and the absorption is very good, suitable for children to supplement.

Therefore, while using comprehensive treatment of pediatric nephrotic syndrome, it is important to supplement vitamin D and calcium to compensate for calcium deficiency and to prevent children from developing hypocalcemic convulsions, hand and foot convulsions, osteoporosis, and fractures. This is very important. .

Is pediatric nephropathy urine milky nephropathy?

Some careful parents often find that their children's urine is milky white like rice water, and they are worried that they may have kidney disease. They go to the hospital for tests, and the results are normal again. This happens mostly because some components of the baby's urine are increased and precipitated. Not harmful to health.

When children eat green leafy vegetables such as spinach and amaranth or fruits such as bananas, oranges and persimmons, these foods contain more oxalates and carbonates, and the amount of salts in their urine increases. When these substances are excreted from urine, When cold, salt crystals such as carbonates or phosphates are discharged, making the urine cloudy. Usually, as long as you pay attention to drink more water or take some vitamin C, the milky urine will disappear after a few days.

Pathological milky urination may be due to pyuria caused by kidney and urethral infections, or it may be caused by lymphatic obstruction caused by filariasis. Therefore, if the color of the urine does not fade after avoiding such foods, you should go to the hospital for further examination to prevent the disease from progressing.

Pediatric nephropathy

Scientists from Wake Forest University in the United States recently claimed that a quarter of patients with renal dialysis have a closer blood relationship, which means that there is a certain genetic factor in kidney disease.

The study was co-sponsored by Wake Forest University and Emory University. The researchers conducted the largest survey to date-they surveyed 25,883 newly treated renal dialysis patients in northern California, southern California, and Georgia. Family members of 22.8% of patients were also found to have end-stage renal failure.

Researchers therefore suggest that close family members of patients with kidney disease should be examined to identify potential, undetected patients with kidney disease. "Physicians treating chronic kidney disease should consider reviewing high-risk family members to reduce the exponentially increasing incidence of kidney failure," said Barry Freedman, a nephrology professor at Wake Forest University Medical Center.

The research results were published in the online edition of the recently published American Journal of Nephrology.