Volume regulation in children with early relapse of minimal-change nephrosis with or without hypovolaemic symptoms
| Autor: | Frans H.M. Derkx, H. A. Koomans, J. G. Vande Walle, J.W. van Isselt, R. A. Donckerwolcke, J. A. Joles |
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| Rok vydání: | 1995 |
| Předmět: |
Male
medicine.medical_specialty Renal Plasma Flow Adolescent Nephrosis Kidney Plasma renin activity Gastroenterology chemistry.chemical_compound Norepinephrine Atrial natriuretic peptide Internal medicine Hypovolemia Renin medicine Humans Child Aldosterone Serum Albumin Hypoproteinemia Blood Volume business.industry Nephrosis Lipoid Sodium Kidney metabolism General Medicine medicine.disease Proteinuria Endocrinology chemistry Renal blood flow Child Preschool Female medicine.symptom business Nephrotic syndrome Atrial Natriuretic Factor Glomerular Filtration Rate |
| Zdroj: | Lancet (London, England). 346(8968) |
| ISSN: | 0140-6736 |
| Popis: | The cause of sodium retention in nephrotic syndrome is unclear. Hypovolaemia has traditionally been labelled as the cause but there is evidence in adults of a renal disturbance as the main cause. We aimed to find out whether children with early nephrosis can be classified as hypovolaemic by objective measures. We measured blood volume, kidney function, and hormone concentrations in children with early relapse of minimal-change nephrosis. Three presentations could be defined. The first was patients with incipient proteinuria and normal plasma protein, characterised by sodium retention, increased renal plasma flow, and slightly increased aldosterone, but normal noradrenaline. The second was patients with severe proteinuria, hypoproteinaemia, and hypovolaemic symptoms, who had oedema, sodium retention, and high concentrations of plasma renin, aldosterone, and noradrenaline, low atrial natriuretic peptide, and low glomerular filtration rate. The third was patients with equally severe proteinuria and hypoproteinaemia, but without hypovolaemic symptoms; they had oedema, but no active sodium retention, and normal plasma hormones and glomerular filtration. Neither blood pressure nor blood volume discriminated patients with or without hypovolaemic symptoms. These findings show that children with early full-blown nephrosis can present both with and without hypovolaemic symptoms and laboratory signs, despite equally severe hypoproteinaemia, and also that sodium retention precedes the reduction in serum protein. |
| Databáze: | OpenAIRE |
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