Nephrology Dialysis Transplantation, Vol 13, Issue 9 2348-2350, Copyright © 1998 by Oxford University Press
A de Boer, C Schroder, R Reddingius, H Willems and L Monnens
Background: The passage of proteins across the
glomerular filtration barrier is mainly determined by the size of the
protein. In nephrotic syndrome (NS) the glomerular permselectivity is
affected, causing proteinuria. Some authors suggest the existence of a
generalized basement membrane defect. The permeability characteristics of
the peritoneal basement membrane in children with NS are not known.
Methods: The transperitoneal transport of proteins
with a different molecular weight ({beta}2-microglobulin MW 11 800 D,
albumin MW 69 000 D, IgG MW 160 000 D, and &agr;2-macroglobulin MW 820
000 D) was studied in a study group (group A) consisting of six stable
nephrotic children (three with glomerulosclerosis and three with congenital
nephrotic syndrome, one of them with mesangial sclerosis) and compared to a
control group (group B) consisting of eight stable children on peritoneal
dialysis. After a dwell of 6 h with Dianeal 1.36% dialysate and serum
samples were collected. For each patient the dialysate to plasma (D/P)
ratio of the four proteins were calculated. The D/P ratios of the nephrotic
patients in group A were compared to the D/P ratios of the patients in the
control group B. Data were expressed as mean ±SD.
Results: The values for the D/P ratios (in percentage)
of {beta}2-microglobulin, albumin, IgG and &agr;2-macroglobulin in
group A were 19.6±9.9, 2.7±1.7, 1.6±0.9,
and 0.5±0.4, compared to 24.9±10.2,
4.0±2.3, 2.2±1.2, and 0.7±0.3 in the
control group B. The ratios were plotted against MW on a double logarithmic
scale. In all patients a linear relationship between molecular weight and
D/P ratio of the proteins was obtained. The D/P ratios of the study group
did no differ significantly from the control group.
Conclusion: We conclude that the size selectivity of
the capillary permeability is not affected in the peritoneal membrane in
children with NS due to glomerulosclerosis and congenital nephrotic
syndrome. Key words: children; nephrotic syndrome;
peritoneal dialysis; protein loss
PRELIMINARY REPORTS
Peritoneal protein loss in children with nephrotic syndrome during peritoneal dialysis
Departments of Paediatrics and Clinical Chemistry, University Hospital Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands; Department of Paediatrics, University Hospital Utrecht, Utrecht, The Netherlands; Corresponding author
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