Pattern of Sodium Retention among Children with Oedematous Nephrotic Syndrome in a Tertiary Care Hospital of West Bengal.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 17, Issue 2
Abstract
Background: Nephrotic syndrome is a common renal disease in childhood where abnormal sodium and water retention occur. This leads to expansion of interstitial fluid volume and oedema. It has been hypothesized that sodium retention by the kidney is a primary phenomenon occurring in response to intrarenal rather than systemic mechanism, i.e., renin-angiotensin-aldosterone system. There are recent evidences of increased Na+K +ATPase and enhanced epithelial sodium channel (ENaC) activity leading to primary sodium retention in the collecting duct. Clinical evaluation of volume status in presence of substantial oedema is not always accurate. Urinary markers are very useful as surrogate marker of volume and sodium retention status. Objective: To find out the proportion of primary and secondary sodium retention among oedematous nephrotic syndrome cases, prevalence of hypovolemic and non-hypovolemic cases and to examine relationship between serum albumin level and duration of oedema with different sodium retention status. Methodology: It was a cross-sectional study on children of steroid sensitive and relapsed nephrotic syndrome cases presenting at Pediatric department of Medical College, Kolkata form April 2015 to June 2016. Total 73 patients of 1 to 12 years age and within 14 days of onset of edema were studied who were not already on steroid or diuretic or ACE inhibitor. Study parameters were blood for Na+ , K+ , urea, creatinine, albumin and urine for Na+ , K+ and creatinine. Data analysis was done in Excel Workbook, Chi-square test was used with p≤0.05 significance level. Result: Among 73 edematous children 19% have secondary Na+ retention with intravascular volume depletion, 55% have primary Na+ retention with non-hypovolemic status and remaining 26% have no Na+ retention with non-hypovolemic status and mostly associated with natriuresis. Conclusion: Intrarenal mechanism of Na+ retention play major role in edema formation. Edematous patient with primary Na+ retention are nonhypovolemic. Serum albumin observed to be significantly low in cases of secondary Na+ retention. Duration of oedema is comparatively less with primary type of Na+ retention than the secondary type. Hypovolemia occurs in minority of patients mostly of which have significantly low serum albumin and late presenter with massive edema. Use of diuretic would be safe in the edema forming phase of nephrotic syndrome only if secondary Na+ retention with hypovolemia can be excluded or intravascular volume corrected.
Authors and Affiliations
Dr. Santa Saha (Roy), Dr. Dibyendu Raychaudhuri, Dr. Goutam Ghosh, Dr. Debasis Das, Dr. Dona Banerjee, Professor Dr. Kalpana Datta,
Keywords
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- EP ID EP361795
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