Skip to main content
SpringerLink
Log in

Peritoneal protein losses in children with steroid-resistant nephrotic syndrome on continuous-cycler peritoneal dialysis

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Glomerular protein permeability rises in nephrotic syndrome and may result from the effect of an unidentified “circulating factor.” The effect of this “circulating factor” on the permeability of other body membranes is unknown. In this study we examine the peritoneal membrane protein permeability in patients with nephrotic syndrome on chronic-cycler peritoneal dialysis. We conducted a retrospective study of peritoneal protein losses in the dialysate effluent of 60 pediatric peritoneal dialysis patients (ages 5.1–22 years) over a 6-year period (January 1997–December 2002). Nineteen patients had steroid-resistant nephrotic syndrome (SRNS), while 41 had other non-nephrotic etiologies of renal failure. Total and normalized peritoneal protein losses are higher in SRNS than in non-nephrotic patients (12,603±5,403 mg/day vs 4,475±469 mg/day, P<0.05; 297.8±79.3 mg/kg per day vs 156.8±16.0 mg/kg per day, P<0.05; 9,614.6±3,253.4 mg/m2 per day vs 4,168.3±367.3 mg/m2 per day, P<0.05). The ratio of total protein in dialysate to plasma, a measure of peritoneal membrane protein permeability, was higher in SRNS patients (3.50±1.00% vs 0.68±0.06%, P<0.001). Serum albumin concentration was lower in SRNS patients (3.09±0.13 mg/dl vs 3.52±0.07 mg/dl, P<0.01). There were no differences between the two groups with regard to duration of peritoneal dialysis, dialysis prescription, numbers of peritonitis episodes, catheter replacements, or hospitalizations. In summary, these results demonstrate that peritoneal protein losses in patients with SRNS are twice as great as in those without nephrotic syndrome. These results are consistent with the systemic effect of a “circulating factor” in SRNS and underscore the importance of adequate protein intake in patients on peritoneal dialysis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Vernier RL (1987) Primary nephrotic syndrome. In: Holliday MA, Barratt TM, Vernier RL (eds) Pediatric nephrology, 2nd edn, Williams & Williams, Baltimore, pp 448–452

    Google Scholar 

  2. Winetz JA, Robertson CR, Golbetz HV, Carrie BJ, Salyer WR, Myers BD (1981) The nature of the glomerular injury in minimal change and focal sclerosing glomerulopathies. Am J Kidney Dis 1:91–98

    Article  CAS  Google Scholar 

  3. Nash MD, Edelman CM, Bernstein J, Barnett HL (1992) The nephrotic syndrome. In: Edelman CM (ed) Pediatric kidney disease, 2nd edn, Little, Brown, Boston, pp 1247–1254

    Google Scholar 

  4. International Study of Kidney Disease in Childhood (1979) “Nephrotic syndrome in Children.” A randomized trial comparison of two prednisone regimens in steroid responsive patients who relapse early. J Pediatr 95:239

    Article  Google Scholar 

  5. Feld SM, Figueroa P, Savin V, Nast CC, Sharma R, Sharma M, Hirschberg R, Adler SG (1988) Plasmapheresis in the treatment of steroid-resistant focal and segmental glomerulosclerosis in native kidneys. Am J Kidney Dis 32:230–237

    Article  Google Scholar 

  6. Artero ML, Sharma R, Savin VJ, Vincenti F (1994) Plasmapheresis reduces proteinuria and serum capacity to injure glomeruli in patients with recurrent focal glomerulosclerosis. Am J Kidney Dis 23:574–581

    Article  CAS  Google Scholar 

  7. Sharma M, Sharma R, Reddy SR, McCarthy ET, Savin VJ (2002) Proteinuria after injection of human focal segmental glomerulosclerosis factor. Transplantation 73:366–372

    Article  Google Scholar 

  8. Quan A, Baum M (1996) Protein losses in children on continuous cycler peritoneal dialysis. Pediatr Nephrol 10:728–731

    Article  CAS  Google Scholar 

  9. Ellis D, Kapur S, Antonovych TT, Salcedo JR, Yunis EJ (1978) Focal glomerulosclerosis in children: correlation of histology with prognosis. J Pediatr 93:762–768

    Article  CAS  Google Scholar 

  10. Mellits ED, Cheek DB (1970) The assessment of body water and fatness from infancy to adulthood. Monogr Soc Res Child Dev 35:12–26

    Article  CAS  Google Scholar 

  11. Cameron JS, Turner DR, Ogg CS, Chantler C, Williams DG (1978) The long term prognosis of patients with focal segmental glomerulosclerosis. Clin Nephrol 10:213–218

    CAS  PubMed  Google Scholar 

  12. Hoyer JR, Vernier RL, Najarian JS, Raij L, Simmons RL, Michael AF (1972) Recurrence of idiopathic focal segmental glomerulosclerosis in children. Lancet 2:343–348

    Article  CAS  Google Scholar 

  13. Malekzadeh MH, Heuser ET, Ettenger RB, Pennisi AJ, Uittenbogaart CH, Warshaw BL, Fine RN (1979) Focal glomerulosclerosis and renal transplantation. J Pediatr 95:249–254

    Article  CAS  Google Scholar 

  14. Lewis EJ (1982) Recurrent focal sclerosis after renal transplantation. Kidney Int 22:315–323

    Article  CAS  Google Scholar 

  15. Verani RR, Hawkins EP (1986) Recurrent focal segmental glomerulosclerosis: a pathological study of the early lesion. Am J Nephrol 6:263–270

    Article  CAS  Google Scholar 

  16. Morales JM, Andres A, Prieto C, Martinez MA, Praga M, Ruilope LM, Gutierrez Millet V, Rodicio JL (1988) Clinical and histological sequence of recurrent focal segmental glomerulosclerosis. Nephron 48:241–242

    Article  CAS  Google Scholar 

  17. Savin VJ, Sharma R, Sharma M, McCarthy ET, Swan SK, Ellis E, Lovell H, Warady B, Gunwar S, Chonko AM, Artero M, Vincenti F (1996) Circulating factor associated with increased glomerular permeability to albumin in recurrent focal segmental glomerulosclerosis. N Engl J Med 334:878–883

    Article  CAS  Google Scholar 

  18. Senggutuvan P, Cameron JS, Hartley RB, Rigden S, Chantler C, Haycock G, Williams DG, Ogg C, Koffman G (1990) Recurrence of focal segmental glomerulosclerosis in transplanted kidneys: analysis of incidence and risk factors in 59 allografts. Pediatr Nephrol 4:21–28

    Article  CAS  Google Scholar 

  19. Munoz J, Sanchez M, Perez-Garcia R, Anaya F, Valderrabano F (1985) Recurrent focal segmental glomerulosclerosis in renal transplants. Proteinuria relapsing following plasma exchange. Clin Nephrol 24:213–214

    CAS  PubMed  Google Scholar 

  20. Laufer J, Ettenger RB, Ho WG, Cohen AH, Marik JL, Fine RN (1988) Plasma exchange for recurrent nephrotic syndrome following renal transplantation. Transplantation 46:540–542

    Article  CAS  Google Scholar 

  21. Dantal J, Bigot E, Bogers W, Testa A, Kriaa F, Jacques Y, Hurault de Ligny B, Niaudet P, Charpentier B, Soulillou JP (1994) Effect of plasma protein adsorption on protein excretion in kidney transplant recipients with recurrent nephrotic syndrome. N Eng J Med 330:7–14

    Article  CAS  Google Scholar 

  22. Dantal J, Godfrin Y, Koll R, Perretto S, Jaulet J, Bouhours JF, Soulillou JP (1988) Antihuman immunoglobulin affinity immunoabsorption strongly decreases proteinuria in patients with relapsing nephrotic syndrome. J Am Soc Nephrol 9:1709

    Google Scholar 

  23. Fried L, Piraino B (2000) Peritonitis. In: Gokal R, Khanna R, Krediet R, Noph K (eds) Textbook of peritoneal dialysis, 2nd edn, Kluwer, Boston, pp 545–598

    Chapter  Google Scholar 

  24. Rubin J, Ray R, Barnes T, Bower J (1981) Peritoneal abnormalities during infectious episodes of continuous ambulatory peritoneal dialysis. Nephron 29:124–127

    Article  CAS  Google Scholar 

  25. Blumenkrantz MJ, Gahl GM, Kopple JD, Kamdar AV, Jones MR, Kessel M, Coburn JW (1981) Protein loss during peritoneal dialysis. Kidney Int 19:593–602

    Article  CAS  Google Scholar 

  26. Burkart JM (2000) Adequacy of peritoneal dialysis. In: Gokal R, Khanna R, Krediet R, Nolph K (eds) Textbook of peritoneal dialysis, 2nd edn, Kluwer Academic, Boston, pp 467–470

    Google Scholar 

  27. Schaefer F, Klaus G, Mehls O (1999) Peritoneal transport properties and dialysis dose affect growth and nutritional status in children on chronic peritoneal dialysis. Mid-European Pediatric Peritoneal Dialysis Study Group. J Am Soc Nephrol 10:1786–1792

    CAS  PubMed  Google Scholar 

  28. de Boer AW, Schröder CH, Reddingius RE, Willems HL, Monnens LAH (1988) Peritoneal protein loss in children with nephrotic syndrome during peritoneal dialysis. Nephrol Dial Transplant 13:2348–2350

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Nephrology, University of TX Southwestern Medical Center, Dallas, TX, 75390-9063, USA

    Sashikala Kopanati & Michel Baum

  2. Children’s Renal Center, Medical City Children’s Hospital, 7777 Forest Lane, Suite A-311, Dallas, TX, 75230, USA

    Albert Quan

Authors
  1. Sashikala Kopanati
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michel Baum
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Albert Quan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Albert Quan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kopanati, S., Baum, M. & Quan, A. Peritoneal protein losses in children with steroid-resistant nephrotic syndrome on continuous-cycler peritoneal dialysis. Pediatr Nephrol 21, 1013–1019 (2006). https://doi.org/10.1007/s00467-006-0012-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-006-0012-y

Keywords

Search

Navigation