Plasma and Blood Volumes in Patients with the Nephrotic Syndrome

Geers, Anton B.; Koomans, H. A.; Boer, P. de; Mees, E. J. Dorhout

doi:10.1159/000183302

Cited by 95 publications

(39 citation statements)

References 12 publications

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“…In healthy control subjects, TER alb has been demonstrated to range from 4.3 to 7.4%/h (17,26 -28). Hildebrandt et al (17) showed a mean TER alb of 9.6% in HD patients before the start of HD, and Geers et al (26) found a TER alb of 9.8 Ϯ 2.6% in patients with the nephrotic syndrome. As a mean, we found an intradialytic TER alb of 9.1 Ϯ 1.3%, which is in line with the aforementioned studies.…”

Section: Discussionmentioning

confidence: 99%

Relative Blood Volume Changes Underestimate Total Blood Volume Changes during Hemodialysis

Dasselaar

Hooge

Pruim

et al. 2007

Clinical Journal of the American Society of Nephrology

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Background: Measurements of relative blood volume changes (⌬RBV) during hemodialysis (HD) are based on hemoconcentration and assume uniform mixing of erythrocytes and plasma throughout the circulation. However, whole-body hematocrit (Ht) is lower than systemic Ht. During HD, a change in the ratio between whole-body to systemic Ht (F cell ratio) is likely to occur as a result of a net shift of low Ht blood from the microcirculation to the macrocirculation. Hence, ⌬RBV may differ significantly from total blood volume changes (⌬TBV). Therefore, this study compared ⌬RBV and ⌬TBV during HD.Design, setting, participants, and measurements: Plasma and erythrocyte volumes were measured using 125 I-and 123 Iradioiodinated albumin and 51 Cr-labeled erythrocytes, respectively. After validation of the standardized method in two patients on a nondialysis day, seven patients completed the protocol during HD.125 I-albumin and 51 Cr-labeled erythrocytes were administered 20 min before the start of HD.123 I-albumin was administered at 160 min into the HD session to quantify and correct for 125 I-albumin leakage. ⌬RBV was measured continuously throughout HD. The F cell ratio was derived from whole-body and systemic Ht.Results: Total ultrafiltration volume was 2450 ؎ 770 ml. TBV declined from 5905 ؎ 824 to 4877 ؎ 722 ml during HD. Thus, TBV declined 17.3 ؎ 4.4%, whereas the RBV decline was only 8.2 ؎ 3.7% (P ‫؍‬ 0.001). The F cell ratio increased from 0.896 ؎ 0.036 to 0.993 ؎ 0.049 during HD (P ‫؍‬ 0.002).Conclusions: ⌬RBV significantly underestimates ⌬TBV during HD. The rise in F cell ratio strongly suggests that during HD, blood translocates from the microcirculation to the macrocirculation, probably as a cardiovascular compensatory mechanism in response to hypovolemia.

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Section: Discussionmentioning

confidence: 99%

Relative Blood Volume Changes Underestimate Total Blood Volume Changes during Hemodialysis

Dasselaar

Hooge

Pruim

et al. 2007

Clinical Journal of the American Society of Nephrology

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“…Two hypotheses, he underfill and overfill hypotheses, have been suggested to explain the intravascular state in nephrotic syndrome (1,2,5). Underfill hypothesis refers to the reduced effective circulating blood volume, while overfill hypothesis indicates the expanded intravascular volume (4,5,10,11).…”

Section: Discussionmentioning

confidence: 99%

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

Büyükavcı¹,

Çivilibal²,

Elevli³

et al. 2015

Turk J Med Sci

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Background/aim: 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.

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“…The predominant role of hypovolemia in the development of nephrotic edema has been questioned and the majority of patients with nephrotic syndrome do not experience hypovolemia. [26][27][28][29] However, Furuya et al 6 had reported that four nephrotic syndrome patients with ARF had moderate to severe decrease of the effective renal plasma flow measured by p-aminohippurate clearance in condition of no hypovolemia. In the report of ARF by Vande Walle, 21 on comparing children with minimal change nephrotic syndrome with patients with minimal change nephropathy disease in remission, AKI patients had lower effective renal plasma flow.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury in Adult Idiopathic Nephrotic Syndrome

Chen

Lin

et al. 2011

Renal Failure

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Objective: This study aims to investigate the epidemiology, clinical and histological features, and prognosis of acute kidney injury (AKI) according to RIFLE classification in adult patients with idiopathic nephrotic syndrome. Methods: In this retrospective study, 277 patients with idiopathic nephrotic syndrome were reviewed from June 2005 to June 2009. Results: Fifty-one (18%) patients entered RIFLE class Risk (AKI-R); 24 (9%) patients entered RIFLE class Injury (AKI-I); and 20 (7%) patients entered RIFLE class Failure (AKI-F). Logistic regression analysis showed that severe hypoalbuminemia, increase in age, and being male were risk factors of AKI. Cumulative recovery rates in 3 months for groups AKI-R, AKI-I, and AKI-F were 95%, 100%, and 94%, respectively (p = 0.21). The mean time to recovery for groups AKI-R, AKI-I, and AKI-F was 20 ± 3, 25 ± 4, and 30 ± 5 days, respectively. Cumulative complete remission rates in 3 months for groups AKI-R, AKI-I, and AKI-F were 92%, 86%, and 65%, respectively (p = 0.002). The mean time to remission for groups AKI-R, AKI-I, and AKI-F was 28 ± 3, 39 ± 6, and 62 ± 8 days, respectively. Conclusion: AKI is not uncommon in adult idiopathic nephrotic syndrome. More severe AKI was associated with longer time of nephrotic syndrome complete remission. Renal function can recover completely in most of the patients.

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Plasma and Blood Volumes in Patients with the Nephrotic Syndrome

Cited by 95 publications

References 12 publications

Relative Blood Volume Changes Underestimate Total Blood Volume Changes during Hemodialysis

Relative Blood Volume Changes Underestimate Total Blood Volume Changes during Hemodialysis

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

Acute Kidney Injury in Adult Idiopathic Nephrotic Syndrome

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