5-year-old boy in critical condition after stopping medication for kidney failure

TA (5 years old, Nghe An ) has steroid-resistant nephrotic syndrome, started treatment in January 2023 at the Department of Nephrology and Dialysis, National Children's Hospital. At the end of January 2024, the child was admitted to the hospital with inferior vena cava thrombosis, and was monitored and treated at the Department of Nephrology and Dialysis and the Department of Hematology. The child was controlled, regularly used medication according to the regimen, so the condition improved.

However, because the family realized that the blood clot was no longer a concern, they stopped using the anticoagulant on their own. After 2 weeks, the child developed symptoms of pain and swelling in both legs, especially the right leg. At this time, the family took TA to the local hospital for examination and that same night the child was transferred to the National Children's Hospital.

Doctors at the National Children's Hospital saved the life of a critically ill child who stopped taking medication for nephrotic syndrome (photo: National Children's Hospital).

"Based on clinical experience and considering the child's history of thrombosis, we suspected that the child had a large venous thrombosis that obstructed blood flow to the heart. Immediately, the child underwent paraclinical tests and diagnostic imaging. The results determined that the child had a large, continuous thrombosis from the femoral and bilateral iliac veins spreading to the inferior vena cava and renal veins, with the risk of causing pulmonary and cerebral vascular occlusion, threatening life if not treated promptly," shared Master, Doctor Tran Hoang, Department of Nephrology and Dialysis.

Faced with the child's critical condition, the hospital quickly consulted four specialties: Interventional Radiology, Vascular Surgery, General Surgery, Nephrology and Dialysis to find the optimal solution, ensuring the safest emergency surgery to save the child's life.

Dr. Vu Manh Hoan, Head of the Department of Hepatobiliary - Pancreatic Surgery, Deputy Director of the General Surgery Center, said: The patient had a blood clot occupying the entire inferior vena cava, from the femoral and iliac veins on both sides spreading to the posterior hepatic vena cava. Therefore, controlling the upper end of the inferior vena cava is very difficult, requiring control of the entire inferior vena cava above the liver, the right hepatic vein, the left and middle hepatic vein trunks.

At the same time, in coordination with Associate Professor, Dr. Nguyen Ly Thinh Truong - Director of the Cardiovascular Center, the team performed surgery to open the inferior vena cava and completely remove the blood clot. Just a small mistake can cause the blood clot to move to the right heart chamber, causing pulmonary embolism, affecting the life of the child, along with the risk of bleeding during surgery when exposing large blood vessels. Therefore, the team tried to be careful and precise in every operation.

After surgery, the patient was transferred to the Department of Surgical Intensive Care. Here, the child was put on a ventilator, maintained vital functions, and given anticoagulants to ensure that no new blood clots formed and to control blood clotting. The child's condition was stable and he recovered well, so he was taken off the ventilator after a few hours and transferred to the Department of Nephrology and Dialysis for continued monitoring and treatment.

Currently, the child is receiving combined medical treatment, with stable and clinically improved indicators, reduced symptoms such as pain, swelling, and edema, and normal eating and drinking.

From the case of this child, doctors recommend that children with nephrotic syndrome with or without a history of thrombosis should be monitored and re-examined regularly according to the hospital's appointment schedule; adhere to the treatment regimen, and absolutely do not stop taking medication on your own. If the child shows signs of swelling, pain, purple edema, difficulty breathing, cyanosis, or any other recurrent symptoms of nephrotic syndrome and venous thrombosis, parents should take the child to the doctor immediately to avoid unfortunate consequences.

Source: https://www.baogiaothong.vn/be-trai-5-tuoi-nguy-kich-vi-bo-thuoc-dieu-tri-chung-than-thu-192240411113600154.htm