Mehmet Akif BÜYÜKAVCI, Mahmut ÇİVİLİBAL, Murat ELEVLİ, Hatice Nilgün Selçuk DURU

Hypo- and hypervolemic edema in children with steroid sensitive nephrotic syndrome

The mechanism of edema formation in nephrotic syndrome is still poorly understood. We aimed to evaluate the volume status in children with steroid-sensitive nephrotic syndrome (SSNS) and to emphasize the importance of echocardiography in demonstrating of volume changes. Materials and methods: Thirty-two SSNS patients and 30 healthy children were enrolled in this study. The volume statuses of patients were evaluated by clinical and laboratory features, including fractional sodium excretion (FENa) and distal sodium/potassium exchange (UK/UNa+K ratio). Inferior vena cava collapsibility index (IVCCI), left atrial diameter (LAD), aortic diameter (AD), and left ventricular mass index (LVMI) were measured using conventional echocardiographic methods. Results: FENa was lower in children with NS; however, the distal K/Na ratio of the patient and control groups did not differ. In addition, IVCCI, LAD, AD, and LVMI were not different among groups. When evaluating the volume status of patients, 8 patients (25%) were hypovolemic while 24 patients (75%) were nonhypovolemic (normovolemic or hypervolemic). LAD was significantly lower in hypovolemic patients. Conclusion: The majority of children with SSNS are normovolemic or hypervolemic and echocardiography is an easy and valuable method for the evaluation of volume status in these patients.

Anahtar Kelimeler:

Children, edema, inferior vena cava collapsibility index, left atrial diameter, nephrotic syndrome, sodium

Hypo- and hypervolemic edema in children with steroid sensitive nephrotic syndrome

Keywords:

Children, edema, inferior vena cava collapsibility index, left atrial diameter, nephrotic syndrome, sodium,

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Van de Walle JG, Donckerwolcke RA. Pathogenesis of edema formation in the nephrotic syndrome. Pediatr Nephrol 2001; 16: 283–293.
Usberti M, Gazzotti RM, Poiesi C, D’Avanzo L, Ghielmi S. Considerations on the sodium retention in nephrotic syndrome. Am J Nephrol 1995; 15: 38–47.
Ichikawa I, Rennke HG, Hoyer JR, Badr KF, Schor N, Troy JL, Lechene CP, Brenner BM. Role for intrarenal mechanisms in the impaired salt excretion of experimental nephrotic syndrome. J Clin Invest 1983; 71: 91–103.
Donmez O, Mir S, Ozyurek R, Cura A, Kabasakal C. Inferior vena cava indices determine volume load in minimal lesion nephrotic syndrome. Pediatr Nephrol 2001; 16: 251–255.
Gurgoze MK, Gunduz Z, Poyrazoglu MH, Dursun I, Uzum K, Dusunsel R. Role of sodium during formation of edema in children with nephrotic syndrome. Pediatr Int 2011; 53: 50–56.
Van de Walle JG, Donckerwolcke RA, Greidanus TB, Joles JA, Koomans HA. Renal sodium handling in children with nephrotic relapse: relation to hypovolemic symptoms. Nephrol Dial Transplant 1996; 11: 2202–2208.
Allon M, Pasque CB, Rodriguez M. Sodium and water excretion in nephrotic patients. Effects of changes in renal haemodynamics. Clin Sci 1990; 79: 123–129
Donckerwolcke RA, France A, Raes A, Walle JV. Distal nephron sodium-potassium exchange in children with nephrotic syndrome. Clin Nephrol 2003; 59: 259–266.
Van de Walle JG, Donckerwolcke RA, van Isselt JW, Derkx FH, Joles JA, Koomans HA. Volume regulation in children with early relapse of minimal change nephrosis with or without hypovolemic symptoms. Lancet 1995; 346: 148–152.
Iyengar AA, Kamath N, Vasudevan A, Phadke KD. Urinary indices during relapse of childhood nephrotic syndrome. Indian J Nephrol 2011; 21: 172–176.
Matsumoto H, Miyaoka Y, Okada T, Nagaoka Y, Wada T, Gondo A, Esaki S, Hayashi A, Nakao T. Ratio of urinary potassium to urinary sodium and the potassium and edema status in nephrotic syndrome. Intern Med 2011; 50: 551–555.
Kapur G, Valentini RP, Imam AA, Mattoo TK. Treatment of severe edema in children with nephrotic syndrome with diuretics alone--a prospective study. Clin J Am Soc Nephrol 2009; 4: 907–913.
Moreno FLL, Hagan JR, Pryor TA, Strickland RD, Castle CH. Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function. Am J Cardial 1984; 53: 579–585.
Cheriex EC, Leunissen KML, Janssen HA, Mooy JMV, van Hooff JP. Echography of the inferior vena cava is a simple and reliable tool for estimation of ‘dry weight’ in haemodialysis patients. Nephrol Dial Transplant 1989; 4: 563–568.
Mitsnefes MM. Cardiovascular complications of pediatric chronic kidney disease. Pediatr Nephrol 2008; 23: 27–39.
Sladowska-Kozłowska J, Litwin M, Niemirska A, Wierzbicka A, Wawer ZT, Janas R. Change in left ventricular geometry during antihypertensive treatment in children with primary hypertension. Pediatr Nephrol 2011; 26: 2201–2209.
Civilibal M, Caliskan S, Oflaz H, Sever L, Candan C, Canpolat N, Kasapcopur O, Bugra Z, Arisoy N. Traditional and “new” cardiovascular risk markers and factors in pediatric dialysis patients. Pediatr Nephrol 2007; 22: 1021–1029.
Jakrapanichakul D, Chirakarnjanakorn S. Comparison of aortic diameter in normal subjects and patients with systemic hypertension. J Med Assoc Thai 2011; 94 (Suppl. 1): S51–56.
Cuspidi C, Meani S, Fusi V, Valerio C, Sala C, Zanchetti A. Prevalence and correlates of aortic root dilatation in patients with essential hypertension: relationship with cardiac and extracardiac target organ damage. J Hypertens 2006; 24: 573– 580.