Division of Pediatric Nephrology, Luis Calvo Mackenna Children's Hospital, University of Chile, Santiago, Chile.
Perit Dial Int. 2012 Jul-Aug;32(4):437-43. doi: 10.3747/pdi.2009.00251. Epub 2012 Apr 2.
Nephrotic syndrome (NS) in children has been associated with a systemic circulating permeability factor. Therefore, once peritoneal dialysis (PD) has been started, peritoneal protein losses should be higher in the nephrotic than in the non-nephrotic population.
We compared peritoneal protein losses in children with and without NS on PD.
Our retrospective 4-year study analyzed Hispanic patients with NS under PD. Data at dialysis entry and 6 months later were compared. Nutritional support was given according to recommended dietary allowances and recommendations from the Kidney Disease Outcomes Quality Initiative. Clinical and biochemical data were obtained, and 24-hour dialysate and urine samples were collected to measure protein losses. Dialysis dose (Kt/V), daily protein intake (DPI), normalized protein equivalent of nitrogen appearance (nPNA), peritoneal equilibration test (PET), and peritonitis rate were determined. All measurements took place at least 4 weeks after resolution of a peritonitis episode. All patients received automated PD using a HomeChoice PD System cycler (Baxter Healthcare Corporation, Deerfield, IL, USA), with an exchange volume of 1100 mL/m(2) and a dextrose concentration of 1.5% - 2.5%. A control group of non-NS children on PD matched by age and sex were also studied. Data are reported as mean ± standard deviation. Differences between groups were calculated using the Mann-Whitney U-test, and p < 0.05 was considered significant.
Each study group consisted of 10 patients [NS patients: 4 boys, mean age of 7.3 ± 4.1 years; control patients: 6 boys, mean age of 7.2 ± 4.7 years (p = nonsignificant)]. In the group with NS, 8 patients were diagnosed by biopsy as having focal segmental glomerulosclerosis, and 2 as having minimal-change disease. At study entry, patients with NS had hourly urinary protein losses of 398 ± 313 mg/m(2) and daily peritoneal protein losses of 3.4 ± 1.9 g/m(2), compared with 29.9 ± 31 mg/m(2) and 1.5 ± 1.1 g/m(2) respectively in the control group (p < 0.05). The same statistical difference was found 6 months later. We observed no statistical differences in PET results, daily exchange volume, and mean dextrose concentration of dialysate. Similarly, no significant between-group differences were observed for Kt/V, DPI, nPNA, and biochemical parameters.
Hispanic children with NS on PD show higher peritoneal protein losses than do their control counterparts. Such differences could be secondary to increased peritoneal permeability caused by a systemic permeability factor.
儿童肾病综合征（NS）与全身性循环通透性因子有关。因此，一旦开始腹膜透析（PD），肾病综合征患者的腹膜蛋白丢失应该高于非肾病综合征患者。
我们比较了 PD 治疗下有和没有 NS 的儿童的腹膜蛋白丢失情况。
我们进行了一项回顾性的 4 年研究，分析了 PD 治疗下的 Hispanic 肾病综合征患者。比较了透析开始时和 6 个月后的患者数据。根据推荐的膳食允许量和肾脏病预后质量倡议的建议，给予营养支持。获得临床和生化数据，并收集 24 小时透析液和尿液样本以测量蛋白丢失。测定透析剂量（Kt/V）、每日蛋白摄入量（DPI）、标准化蛋白氮表观量（nPNA）、腹膜平衡试验（PET）和腹膜炎发生率。所有测量均在至少 4 周后腹膜炎发作缓解后进行。所有患者均使用 HomeChoice PD 系统（Baxter Healthcare Corporation，Deerfield，IL，USA）接受自动 PD，交换量为 1100 mL/m²，葡萄糖浓度为 1.5%至 2.5%。还研究了一组年龄和性别相匹配的 PD 治疗下非 NS 儿童作为对照组。数据以平均值±标准差表示。使用 Mann-Whitney U 检验计算组间差异，p＜0.05 被认为具有统计学意义。
每个研究组均包含 10 名患者[NS 患者：4 名男性，平均年龄 7.3±4.1 岁；对照组患者：6 名男性，平均年龄 7.2±4.7 岁（p=无显著性差异）]。在 NS 组中，8 名患者经活检诊断为局灶节段性肾小球硬化症，2 名患者为微小病变病。在研究开始时，NS 组患者的每小时尿蛋白丢失量为 398±313mg/m²，每日腹膜蛋白丢失量为 3.4±1.9g/m²，而对照组患者的相应值分别为 29.9±31mg/m²和 1.5±1.1g/m²（p＜0.05）。6 个月后也观察到了相同的统计学差异。我们未观察到 PET 结果、每日交换量和透析液中平均葡萄糖浓度的统计学差异。同样，Kt/V、DPI、nPNA 和生化参数也没有明显的组间差异。
PD 治疗下的 Hispanic 肾病综合征儿童腹膜蛋白丢失高于对照组。这种差异可能是由于全身性通透性因子引起的腹膜通透性增加所致。
