Pérdidas Proteicas Peritoneales en Niños Portadores de Síndrome Nefrótico en Diálisis Peritoneal

Abstract

Primary Nephrotic Syndrome (NS) responds favorably to steroids in 80-90% of cases. Most corticoresistant (CR) patients evolve into Chronic Renal Failure (CRF), Of unknown origin, a permeability factor in these patient's serum has been reported, with some known effects in membranes including the peritoneum. Objective: To evaluate peritoneal protein loss in CR children on Chronic Peritoneal Dialysis (CPD). Patients and Methods: Four year retrospective analysis. Group 1 included 9 CR children, Group 2 was a control group of 10 children with CRF of other causes on CPD. Children in both groups were comparable in age, gender, weight, body surface, duration of CPD, concentration of solution, modality and dose of dialysis. Both groups were evaluated at 1, 6 and 12 months after admission. Results: No differences were observes in biochemical parameters: creatinine, urea nitrogen, calcium, phosphorus. PTH (Parathyroid hormone) was significantly higher in the control group (164 ± 144 vs 564 ± 454 pg/dl p < 0,05), albumin was lower in NS patients at the beginning (2.27 ± 0.63 gr/dl vs 3.62 ± 1.45 gr/dl p < 0,05) and end (2.8 ± 0.5 gr/ dl vs 3.9 ± 0.86 gr/dl, p < 0,05) of the evaluation. Peritoneal protein loss was significantly larger in the index group at the beginning (3,41 ± 2,01 vs 1,76 ± 1,45 gr/m 2 /día), and end (4,27 ± 3,47 vs 1,66 ± 1,31 gr/m 2 /día, (p < 0.05) of the evaluation. The same happened with urinary loss: while there was no difference in protein intake, peritoneal KtV or total KtV between groups, residual KtV was significantly lower among NS patients at the end of the study, suggesting an earlier drop in residual renal function. No differences were observed in rates of peritonitis between groups in the study period. Conclusion: Peritoneal protein loss in CPD children with NS are significantly larger than other patients in CPD, suggesting a possible systemic permeability factor in these patients.