TITLE:
Refractory Oedema of Nephrotic Syndrome in a Resource Poor Setting: A Case Presentation
AUTHORS:
Nneka Chioma Okoronkwo, Chukwuemeka Ngozi Onyearugha, Ikechukwu Frank Ogbonna
KEYWORDS:
Nephrotic Syndrome, Refractory Oedema, Childhood
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.7 No.1,
January
12,
2018
ABSTRACT: Background: Oedema, a constant feature of childhood nephrotic syndrome can be severe, enough to cause respiratory embarrassment. It can also be refractory to diuretic monotherapy. In such cases, combination of salt poor albumin (SPA) infusion and diuretics has remained the best treatment option. However, the cost of SPA has made it practically unavailable in resource-poor settings. It becomes a therapeutic dilemma when nephrotic syndrome patients of financially-constrained caregivers present with refractory anasarca in a resource-poor settings. Case review: We present a seven-year-old boy with relapsed steroid sensitive nephrotic syndrome who presented to Abia State University Teaching Hospital Aba, in respiratory distress with anasarca and a weight of 58 kilograms. SPA could not be accessed due to financial constraints. A decision to use fresh whole blood in the place of SPA, in combination with frusemide, achieved a lifesaving diuresis and regression of the anasarca. Conclusion: Whole blood is a good alternative for the treatment of refractory oedema in children with nephrotic syndrome in resource poor settings.