2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by VANDE WALLE, J. G. J. Articles by KOOMANS, H. A. Search for Related Content PubMed PubMed Citation Articles by VANDE WALLE, J. G. J. Articles by KOOMANS, H. A.

Pathophysiology of Edema Formation in Children with Nephrotic Syndrome Not Due to Minimal Change Disease

JOHAN G. J. VANDE WALLE^*,, RAYMOND A. DONCKERWOLCKE^*, and HEIN A. KOOMANS^§

^* Department of Pediatric Nephrology in Wilhelmina's Children Hospital Utrecht, The Netherlands
Department of Pediatric Nephrology in University Hospital Ghent, Belgium
Department of Pediatric Nephrology in Albertas Children Hospital, Calgary, Canada
^§ Department of Nephrology and Hypertension, University Hospital Utrecht, The Netherlands.

Correspondence to Dr. Hein A. Koomans, Department of Nephrology and Hypertension, University Hospital Utrecht, Room F03.226, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Phone: 31 30 2507329; Fax: 31 30 2543492; E-mail: H.A.Koomans{at}DIGD.AZU.NL

Abstract. 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 (V_max) 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, V_max, 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.

This article has been cited by other articles:

				T. D. Vuong, B. Braam, N. Willekes-Koolschijn, P. Boer, H. A. Koomans, and J. A. Joles Hypoalbuminaemia enhances the renal vasoconstrictor effect of lysophosphatidylcholine Nephrol. Dial. Transplant., August 1, 2003; 18(8): 1485 - 1492. [Abstract] [Full Text] [PDF]

				T. D. Vuong, B. Braam, N. Willekes-Koolschijn, P. Boer, H. A. Koomans, and J. A. Joles Hypoalbuminaemia enhances the renal vasoconstrictor effect of lysophosphatidylcholine Nephrol. Dial. Transplant., August 1, 2003; 18(88): 1485 - 1492. [Abstract] [Full Text]

				A.K.C. Leung and W.L.M. Robson Oedema in childhood The Journal of the Royal Society for the Promotion of Health, December 1, 2000; 120(4): 212 - 219. [Abstract] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673