Distal nephron sodium-potassium exchange in children with nephrotic syndrome

Donckerwolcke, R. A.; Raes, Ann; Walle, Johan Vande

doi:10.5414/cnp59259

Cited by 21 publications

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“…They proposed that patients with NS and VE have normal FeNa and can be managed by diuretics alone (18,19,30). In their studies, mean FeNa in NS patients with early relapse with hypovolemic symptoms was 0.3%, notably lower than that seen in those without hypovolemic (1.1%) symptoms (18,30). The difference in the FeNa between their study and ours is most likely related to sodium intake of the patients.…”

Section: Discussionmentioning

confidence: 54%

“…VC patients had significantly higher renin, aldosterone, and ADH concentration in comparison to the VE group (Table 2, VC ϭ 8, VE ϭ 9). As a further measure of aldosterone effect, urinary potassium index (18,19) [(U K ϫ 100)/(U K ϩ U Na )] was also evaluated (n ϭ 12). Similar to serum aldosterone, urinary potassium index was significantly higher in the VC group (n ϭ 6, mean ϭ 91.4 Ϯ 5.1) compared with the VE group (n ϭ 6, mean 32.8 Ϯ 14.9).…”

Section: Resultsmentioning

confidence: 99%

“…Vande Walle et al evaluated the pathophysiology of edema in NS under controlled salt and water intake and proposed the presence of a subset of patients with overfilling who can be safely treated with diuretics alone (18,19,29,30). Laboratory indices used in the past to differentiate VE from VC include PRA/aldosterone, atrial natriuretic peptide, FeNa, and urine osmolality (19,30,31).…”

Section: Discussionmentioning

confidence: 99%

“…Laboratory indices used in the past to differentiate VE from VC include PRA/aldosterone, atrial natriuretic peptide, FeNa, and urine osmolality (19,30,31). They proposed that patients with NS and VE have normal FeNa and can be managed by diuretics alone (18,19,30). In their studies, mean FeNa in NS patients with early relapse with hypovolemic symptoms was 0.3%, notably lower than that seen in those without hypovolemic (1.1%) symptoms (18,30).…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Treatment of Severe Edema in Children with Nephrotic Syndrome with Diuretics Alone — A Prospective Study

Kapur¹,

Valentini²,

Imam³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objective: Severe edema in children with nephrotic syndrome (NS) may be associated with volume contraction (VC) or volume expansion (VE). Usually, severe edema in children is treated with intravenous (IV) albumin and diuretics, which is appropriate for VC patients. However, in VE patients, this can precipitate fluid overload. The objective of this study was to evaluate treatment of severe edema in NS with diuretics alone.Design, setting, participants, & measurements: Thirty NS patients with severe edema were enrolled in this prospective study in two phases. VC was diagnosed based on fractional excretion of sodium (FeNa) <1%. VC patients received IV albumin and furosemide. VE patients received IV furosemide and oral spironolactone. On the basis of phase 1 observations, FeNa <0.2% identified VC in 20 phase 2 patients.Results: All phase 1 patients had FeNa <1%. Phase 1 patients when reanalyzed based on a FeNa cutoff of 0.2%; it was noted that VC patients had higher BUN, BUN/creatinine ratio, urine osmolality, and lower FeNa and urine sodium compared with VE patients. Similar results were observed in phase 2. VC patients had significantly higher renin, aldosterone, and antidiuretic hormone levels. In phase 2, 11 VE patients received diuretics alone and 9 VC patients received albumin and furosemide. There was no difference in hospital stay and weight loss in VC and VE groups after treatment.Conclusions: FeNa is useful in distinguishing VC versus VE in NS children with severe edema. The use of diuretics alone in VE patients is safe and effective.

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Section: Discussionmentioning

confidence: 54%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of Severe Edema in Children with Nephrotic Syndrome with Diuretics Alone — A Prospective Study

Kapur¹,

Valentini²,

Imam³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…albumin or diuretics. 19 The tremendously increased Lp (a) levels in nephrotic syndrome are caused by primary genetic as well as disease-related mechanisms. 20 Lp (a), ox-Lp (a) and Lp (a)-IC levels were increased in NS, which may play an important role in the processes of atherosclerosis.…”

Section: Resultsmentioning

confidence: 99%

The study of lipid profile, LP (a) and electrolytes with oxidative stress, total protein and albumin in nephrotic syndrome

Dwivedi

Sarkar

2014

Int J Res Med Sci

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Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome: a provisional study

et al. 2017

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A subgroup of patients in nephrotic syndrome has a decrease in glomerular filtration, apparently related to hypovolemia which likely can be detected by a urinary potassium to potassium plus sodium ratio > 0.5-0.6 suggesting benefit of albumin infusion in this subgroup. What is Known: • Volume status can be difficult to assess based on clinical parameters in nephrotic syndrome, and albumin infusion can be associated with development of pulmonary edema and fluid overload in these patients. What is New: • Urinary potassium to the sum of urinary potassium plus sodium ratio can accurately detect hypovolemia in nephrotic syndrome and thus identify those children who would probably respond to albumin infusion.

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Distal nephron sodium-potassium exchange in children with nephrotic syndrome

Cited by 21 publications

References 0 publications

Treatment of Severe Edema in Children with Nephrotic Syndrome with Diuretics Alone — A Prospective Study

Treatment of Severe Edema in Children with Nephrotic Syndrome with Diuretics Alone — A Prospective Study

The study of lipid profile, LP (a) and electrolytes with oxidative stress, total protein and albumin in nephrotic syndrome

Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome: a provisional study

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