[Thromboembolic complications of childhood nephrotic syndrome]. / Complications thromboemboliques du syndrome nephrotique de l'enfant.

BACKGROUND: Vascular thrombosis in the childhood nephrotic syndrome is a rare event. It poses major diagnostic and therapeutic problems. The prognosis depends on early diagnosis and on precocious anticoagulation. The risk of extension of thrombosis and pulmonary embolism is real. AIMS: To consider the major thrombotic events associated with childhood nephrotic syndrome and to establish an appropriate preventive approach based on objective clinical and laboratory parameters. METHODS: This is a retrospective study of all cases of patients suffering from idiopathic nephrotic syndrome, during a period of 20 years, starting from January 1990 to December 2009. We selected six patients with vascular thrombosis. The diagnosis was confirmed by appropriate radiological investigation. RESULTS: Six cases of vascular thrombosis were identified among 260 cases of nephrotic syndrome collected during the period study. Patients are divided into five boys and one girl. The mean age was 13.3 years. The localisation of thrombosis is venous in all cases. One patient presented a massively fatal pulmonary embolism. Sinovenous thrombosis has been objectified in 3 patients who were all treated with a good therapeutic response. CONCLUSION: vascular thrombosis remains one of the most serious complications of nephrotic syndrome in children. Early diagnosis and precocious anticoagulation are essential for preventing the extension of thrombosis.

[Early infections in children following renal transplantation]. / Complications infectieuses precoces chez l'enfant transplante renal.

BACKGROUND: Infections following renal transplantation in children are a major cause of severe morbidity and mortality. Surgery is complex and performed in a subject whose immunological mechanisms are impaired by end stage renal failure and immunosuppressive drugs. AIM: To evaluate the incidence and the risk factors of early infectious following renal transplantation in children. METHODS: Infectious complications were retrospectively monitored in 37 children receiving renal transplantation at our center from 1992 to 2008. RESULTS: Infectious complications identified were dominated by urinary tract infections occurred in 12 patients. The clinical symptomatology is dominated by fever and decrease in health. In 4 patients the urinary infection was asymptomatic. Three patients had pneumonia; the diagnosis was suspected clinically and confirmed by the chest radiography. Three other patients developed sepsis. In one of them, the etiology was a peritonitis related to dialysis catheter. Two transplant showed a herpetic cheilitis and one patient developed a parvovirus infection that evolved well after two transfusions. In all cases, the outcome was favourable with no deaths or impact on graft function. CONCLUSION: After renal transplantation, the disturbance of inflammatory reactions explains the often latent or delayed infectious process making early diagnosis difficult. It is imperative to monitor infectious to minimize morbidity and mortality.

First case of childhood Takayasu arteritis with renal artery aneurysms.

Takayasu arteritis is a large vessel systemic granulomatous vasculitis characterized by stenosis or obliteration of large and medium sized arteries. It commonly involves elastic arteries such as the aorta and its main branches. Renal artery involvement is rare and has not been reported in a child. We report a 12-year-old boy with Takayasu arteritis who developed severe hypertension, proteinuria, microscopic hematuria and renal dysfunction. Conventional angiography demonstrated aneurysms of both renal arteries and multiple microaneurysms of the superior mesenteric artery. This case report illustrates that the children with Takayasu arteritis can develop renal involvement resulting in hematuria, proteinuria and even renal failure.