Pathophysiology of edema formation in children with nephrotic syndrome not due to minimal change disease
Autor: | J. G. J. Vande Walle, H. A. Koomans, R. Donckerwolcke |
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Přispěvatelé: | Kindergeneeskunde, RS: NUTRIM School of Nutrition and Translational Research in Metabolism |
Jazyk: | angličtina |
Rok vydání: | 1999 |
Předmět: |
Male
medicine.medical_specialty Nephrotic Syndrome Nephrosis Kidney chemistry.chemical_compound Hypoproteinemia Internal medicine Edema medicine Humans Minimal change disease Child Congenital nephrotic syndrome Sex Characteristics Blood Volume Aldosterone business.industry Nephrosis Lipoid Sodium Infant nutritional and metabolic diseases Glomerulonephritis General Medicine medicine.disease eye diseases Endocrinology chemistry Nephrology Child Preschool Female medicine.symptom business Nephrotic syndrome |
Zdroj: | Journal of the American Society of Nephrology, 10(2), 323-331. American Society of Nephrology |
ISSN: | 1046-6673 |
Popis: | Department of Pediatric Nephrology in Wilhelmina's Children Hospital Utrecht, The Netherlands. It has been shown that children with nephrotic syndrome due to minimal change disease (MCD) can present with avid salt retention and stimulated vasoactive hormones, as well as with stable edema. The present study examines these conditions in children with nephrotic syndrome not due to MCD (non-MCD). In six children with hypovolemic symptoms (congenital nephrotic syndrome in four), strong sodium retention (fractional sodium excretion, FE(Na), 0.2 +/- 0.2%) was found. Lithium clearance (FE(Li)) and maximal water excretion (Vmax) were suppressed, suggesting avid sodium reabsorption throughout the nephron. Aldosterone, renin, and norepinephrine were elevated. Sixteen other children with non-MCD had stable edema. FE(Na) was 1.8 +/- 1.1%, whereas FE(Li), Vmax, and hormones were normal, and not different from data in 35 nonproteinuric children. In children with MCD, 12 presented with hypovolemic symptoms and strong sodium retention (FE(Na) 0.3 +/- 0.3%), whereas 15 were stable (FE(Na) 1.1 +/- 0.7%). Regarding tubular sodium handling and hormones, the same distinction could be made as for the children with non-MCD. However, hypoproteinemia differed. In the children with non-MCD lesions, plasma colloid osmotic pressure was significantly lower in the hypovolemic types (4.2 +/- 0.4 mmHg) than in those with stable edema (13.0 +/- 3.8 mmHg; P < 0.05); in MCD, no such difference existed (respectively, 8.1 +/- 3.0 and 9.9 +/- 2.2 mmHg). In summary, children with nephrotic syndrome may present with pathophysiologic pictures of decreased effective circulating volume or of stable edema, regardless of whether they have non-MCD or MCD. The pathogenesis of the hypovolemic picture seems to be different, since it is associated with extreme hypoproteinemia only in the children with non-MCD. |
Databáze: | OpenAIRE |
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