Peritoneal Protein Loss in Nephrotic Syndrome on Peritoneal Dialysis

Ahn, Yo Han; Jung, Euiseok; Lee, Se Eun; Lee, Hyun Kyung; Lee, So Hee; Kang, Hee Gyung; Ha, Il Soo; Cheong, Hae Il; Choi, Yong

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+/-0.3 g/dL vs. 4.0+/-0.4 g/dL, P=0.021). Peritoneal protein loss was higher in SRNS patients than in non-SRNS patients (3,044.4+/-837.6 mg/m2/day vs. 1,791.6+/-1,244.0 mg/m2/ 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+/-0.46% vs. 0.58+/-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.