Role of sodium during formation of edema in children with nephrotic syndrome

Gürgöze, Metin Kaya; Gündüz, Zübeyde; Poyrazoğlu, Muammer Hakan; Dursun, İsmail; Üzüm, Kazım; Düşünsel, Ruhan

doi:10.1111/j.1442-200x.2010.03192.x

Cited by 13 publications

(19 citation statements)

References 28 publications

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“…Our results confirmed the studies that demonstrated the importance of sodium reabsorption in proximal tubuli for the development of edema. Gurgoze et al (13) identified intrarenal sodium reabsorption in the pathogenesis of edema in NS. Vande Welle et al (14) detected that the rate of distal tubular potassium-sodium exchange is markedly higher in favor of sodium retention in cases of hypovolemic NS, while in nonhypovolemic patients they did not detect such a significant impact of the distal tubule, in accordance with our results.…”

Section: Discussionmentioning

confidence: 99%

“…For the estimation of circulating blood volume, IVCCI and LAD have been reported as valuable predictive factors. Decreased IVCCI and/or increased LAD indicate the increased volemic status in patients (12,13,21,22). Increased LVMI is defined as an increase in the mass of the left ventricle, which can be secondary to an increase in wall thickness, an increase in cavity size, or both.…”

Section: Discussionmentioning

confidence: 99%

“…It mostly occurs in the proximal renal tubule. Many studies demonstrating proximal tubular sodium reabsorption in the formation of edema are available (12)(13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

“…Donmez et al (12) reported that the IVCCI of edematous NS patients was significantly lower and LAD values were not different from the controls. The study by Gurgoze et al (13) did not include a control group, and NS subgroups were compared among themselves. They found no difference between groups in terms of both the IVCCI and LAD.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…It mostly occurs in the proximal renal tubule. Many studies demonstrating proximal tubular sodium reabsorption in the formation of edema are available (12)(13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

Büyükavcı¹,

Çivilibal²,

Elevli³

et al. 2015

Turk J Med Sci

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“…Comparing patients with and without edema, it was determined that their left atrial diameter and IVCCI values were similar. Moreover, patients with NS tended to be normovolemic instead of being hypovolemic (28). ANP and cGMP are biomarkers used to determine volume load for patients with conditions such as cardiac valve diseases and congestive heart failure affecting the left atrium.…”

Section: Discussionmentioning

confidence: 99%

Bioimpedance for assessing volume status in children with nephrotic syndrome

Özdemir¹,

Mir²,

Dinçel³

et al. 2015

Turk J Med Sci

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Background/aim: The effectiveness of assessing volume load via bioimpedance in pediatric patients with nephrotic syndrome (NS) was investigated.Materials and methods: Patients with NS (n = 34) were compared with healthy controls (n = 20). The inferior vena cava index and inferior vena cava collapsibility index (IVCCI) scores were determined for all subjects. Bioimpedance measurements were used to directly determine volume load. Clinical findings, relative fluid load, and echocardiographic measurements were determined and compared with bioimpedance in calculating volume load. Results:The sensitivity and specificity of bioimpedance in determining volume load were found to be 65% and 90%, respectively. IVCCI was lower in NS patients than in controls. There were also significant differences in IVCCI values between patients with localized and generalized edema. Relative fluid load was higher in NS patients with generalized edema as opposed to patients with localized edema. For calculating volume load, the sensitivity of bioimpedance, clinical findings, and echocardiographic measurements was 87%, 95%, and 83%, respectively, whereas the specificity of determining volume load by bioimpedance, clinical findings, and echocardiographic measurements was 50%, 10%, and 80%, respectively. Conclusion:Our data suggest that bioimpedance may be superior to echocardiography in determining volume load in children with NS, because it is cost-effective, reliable, and relatively simple to perform.

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Urinary serine proteases and activation of ENaC in kidney—implications for physiological renal salt handling and hypertensive disorders with albuminuria

Svenningsen

Andersen

Nielsen

et al. 2014

Pflugers Arch - Eur J Physiol

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Serine proteases, both soluble and cell-attached, can activate the epithelial sodium channel (ENaC) proteolytically through release of a putative 43-mer inhibitory tract from the ectodomain of the γ-subunit. ENaC controls renal Na(+) excretion and loss-of-function mutations lead to low blood pressure, while gain-of-function mutations lead to impaired Na(+) excretion, hypertension, and hypokalemia. We review an emerging pathophysiological concept that aberrant glomerular filtration of plasma proteases, e.g., plasmin, prostasin, and kallikrein, contributes to proteolytic activation of ENaC, both in acute conditions with proteinuria, like nephrotic syndrome and preeclampsia, and in chronic diseases, such as diabetes with microalbuminuria. A vast literature on renin-angiotensin-aldosterone system and volume homeostasis from the last four decades show a number of common characteristics for conditions with albuminuria compatible with impaired renal Na(+) excretion: hypertension and volume retention is secondary to proteinuria in, e.g., preeclampsia and nephrotic syndrome; plasma concentrations of renin, angiotensin II, and aldosterone are frequently suppressed in proteinuric conditions, e.g., preeclampsia and diabetic nephropathy; blood pressure is salt-sensitive in conditions with microalbuminuria/proteinuria; and extracellular volume is expanded, plasma atrial natriuretic peptide (ANP) concentration is increased, and diuretics, like amiloride and spironolactone, are effective blood pressure-reducing add-ons. Active plasmin in urine has been demonstrated in diabetes, preeclampsia, and nephrosis. Urine from these patients activates, plasmin-dependently, amiloride-sensitive inward current in vitro. The concept predicts that patients with albuminuria may benefit particularly from reduced salt intake with RAS blockers; that distally acting diuretics, in particular amiloride, are warranted in low-renin/albuminuric conditions; and that urine serine proteases and their activators may be pharmacological targets.

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Role of sodium during formation of edema in children with nephrotic syndrome

Abstract: Although TBW increases in children with SSNS, intravascular volume is normal. In addition, hypoalbuminemia and sodium retention of the proximal tubule cause edema in children with SSNS.

Cited by 13 publications

References 28 publications

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

Bioimpedance for assessing volume status in children with nephrotic syndrome

Urinary serine proteases and activation of ENaC in kidney—implications for physiological renal salt handling and hypertensive disorders with albuminuria

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