Encephalopathy associated with steroid treated nephrotic syndrome

Four children with nephrotic syndrome convulsed and became comatose during steroid therapy. The attacks were associated with hypokalemia and occurred around the time of diuresis. The blood pressure readings were constant in two patients and transiently increased in the other two during the convulsions. All four patients had poorly controlled proteinuria more than one month before the attacks. Various factors including hypertension with secondary cerebral vasoconstriction, hypercoagulable state leading to cerebral microthrombosis and steroid therapy may have contributed to the problem. It is suggested that monitoring patients with electroencephalogram during steroid therapy in long-standing nephrotic states before diuresis may be useful. Hypokalemia should be taken as an ominous sign.