Peritoneal Protein Loss in Nephrotic Syndrome on Peritoneal Dialysis

Ahn, Yo-Han; Jung, Eui-Seok; Lee, Se-Eun; Lee, Hyun-Gyung; Lee, So-Hee; Kang, Hee-Gyung; Ha, Il-Soo; Jung, Hae-Il; Choi, Yong

doi:2009.13.2.189

J Korean Soc Pediatr Nephrol > Volume 13(2); 2009 > Article

J Korean Soc Pediatr Nephrol 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

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