title: Vomiting in an infant with congenital nephrotic syndrome: Questions.
abstract: BACKGROUND
  Most patients with congenital nephrotic syndrome (CNS) exhibit a failure to thrive. A previous study reported that five of 41 (12 %) infants with CNS had hypertrophic pyloric stenosis (HPS) requiring surgery. The reason for this is undetermined, and there are few reports regarding the relationship between these conditions or their clinical course.
  
  
  METHODS
  We present the case of a 4-month-old girl with CNS. She did not show typical manifestations of HPS, but thickened mucosal and submucosal layers and hypertrophy of the pyloric muscle were detected by repeated ultrasound examinations prior to the diagnosis of HPS. Pyloroplasty was performed to improve her poor weight gain and led to ideal growth.
  
  
  CONCLUSIONS
  Our case indicates that obstruction of the gastric outlet may be strongly associated with poor weight gain in patients with CNS. We should suspect involvement with HPS even if typical symptoms are lacking, and an aggressive intervention may improve poor growth. Thickened edematous mucosal and submucosal layers at the pyloric antrum have the potential to cause the high frequency of HPS in CNS.
authors.affiliation: Department of Pediatrics, Hokkaido University Hospital, Kita 15-jo Nishi 7-Chome, Kita Ward, Sapporo City, Hokkaido, Japan. t-toshi@med.hokudai.ac.jp.
authors.forename: Toshiyuki
authors.identifier: http://orcid.org/0000-0002-8783-3528
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Pediatrics, Hokkaido University Hospital, Kita 15-jo Nishi 7-Chome, Kita Ward, Sapporo City, Hokkaido, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Pediatrics, Hokkaido University Hospital, Kita 15-jo Nishi 7-Chome, Kita Ward, Sapporo City, Hokkaido, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamazaki
authors.affiliation: Department of Pediatrics, Hokkaido University Hospital, Kita 15-jo Nishi 7-Chome, Kita Ward, Sapporo City, Hokkaido, Japan.
authors.forename: Asako
authors.initials: A
authors.lastname: Hayashi
authors.affiliation: Department of Pediatrics, Hokkaido University Hospital, Kita 15-jo Nishi 7-Chome, Kita Ward, Sapporo City, Hokkaido, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Okamoto
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods; D005183:Failure to Thrive / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D009404:Nephrotic Syndrome / Q000150:complications*; D046248:Pyloric Stenosis, Hypertrophic / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D011708:Pylorus / Q000601:surgery*; D014839:Vomiting / Q000209:etiology
keywords: Congenital nephrotic syndrome; Failure to thrive; Vomiting