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Journal of the Korean Society of Pediatric Nephrology 2009;13(2): 189-196. doi: https://doi.org/10.3339/jkspn.2009.13.2.189
복막 투석 중인 신증후군 환자의 복막을 통한 단백 소실
안요한, 정의석, 이세은, 이현경, 이소희, 강희경, 하일수, 정해일, 최용
1서울대학교병원 소아청소년과
2서울대학교병원 소아청소년과
3서울대학교병원 소아청소년과
4서울대학교병원 소아청소년과
5서울대학교병원 소아청소년과
6서울대학교병원 소아청소년과
7서울대학교병원 소아청소년과
8서울대학교병원 소아청소년과
9서울대학교병원 소아청소년과
Peritoneal Protein Loss in Nephrotic Syndrome on Peritoneal Dialysis
Yo-Han Ahn, Eui-Seok Jung, Se-Eun Lee, Hyun-Gyung Lee, So-Hee Lee, Hee-Gyung Kang, Il-Soo Ha, Hae-Il Jung, Yong Choi
1Department of Pediatrics, Seoul National University College of Medicine
2Department of Pediatrics, Seoul National University College of Medicine
3Department of Pediatrics, Seoul National University College of Medicine
4Department of Pediatrics, Seoul National University College of Medicine
5Department of Pediatrics, Seoul National University College of Medicine
6Department of Pediatrics, Seoul National University College of Medicine
7Department of Pediatrics, Seoul National University College of Medicine
8Department of Pediatrics, Seoul National University College of Medicine
9Department of Pediatrics, Seoul National University College of Medicine
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ABSTRACT
Purpose : The pathophysiologic mechanism of nephrotic syndrome is not yet known clearly. At least in some cases, certain 'circulating factors' are thought to increase the glomerular protein permeability. Considering the systemic effect of the circulating factor on peritoneal membrane, we evaluated the loss of protein through peritoneal membrane in patients on peritoneal dialysis due to the end stage renal disease (ESRD) caused by steroid resistant nephrotic syndrome (SRNS).
Methods : We retrospectively reviewed the medical records of 26 pediatric patients on peritoneal dialysis ensued during the period from 2001 to 2007 at our clinic. Twelve patients had SRNS, while 14 patients had ESRD caused by the congenital anomalies of urinary system.
Results : While the other parameters including nPNA indicating the adequacy of protein intake were similar between the two groups, serum albumin was lower in SRNS patients than the non-SRNS patients ($3.7{pm}0.3$ g/dL vs. $4.0{pm}0.4$ g/dL, P=0.021). Peritoneal protein loss was higher in SRNS patients than in non-SRNS patients ($3,044.4{pm}837.6;mg/m^2$/day vs. $1,791.6{pm}1,244.0;mg/m^2$/day, P=0.007). The protein permeability of the peritoneal membrane measured by the ratio of total protein concentration in dialysate to plasma was twice as high in SRNS patients as the non-SRNS ($1.06{pm}0.46%$ vs. $0.58{pm}0.43%$, P=0.010). After 1 year, peritoneal protein loss increased in both patient groups, but to a significantly greater degree in non-SRNS patient (P=0.023).
Conclusion : The results of our study support the notion that in nephrotic syndrome there are some 'circulating factors' with the systemic effect. Since the greater protein loss through peritoneal membrane in SRNS was confirmed in this study, more meticulous nutritional support and close monitoring on the nutrition are required in these patients.
Key words: Nephrotic syndrome | Peritoneal dialysis | Protein loss
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