Peritoneal protein loss in children with nephrotic syndrome during peritoneal dialysis.
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 (beta2-microglobulin MW 11800 D, albumin MW 69000 D, IgG MW 160000 D, and alpha2-macroglobulin MW 820000 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) ratios 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 beta2-microglobulin, albumin, IgG and alpha2-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 not differ significantly from the control group.


CONCLUSIONS
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.
Department of Paediatrics, University Hospital Nijmegen, The Netherlands.
A W
AW
de Boer
C H
CH
Schröder
R E
RE
Reddingius
H L
HL
Willems
L A
LA
Monnens
D000293:Adolescent; D001798:Blood Proteins / Q000737:chemistry / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D015314:Dialysis Solutions / Q000737:chemistry; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000737:chemistry; D007223:Infant; D008297:Male; D008970:Molecular Weight; D009404:Nephrotic Syndrome / Q000378:metabolism* / Q000628:therapy*; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000378:metabolism*; D012709:Serum Albumin / Q000032:analysis / Q000737:chemistry; D000511:alpha-Macroglobulins / Q000032:analysis / Q000737:chemistry; D001613:beta 2-Microglobulin / Q000032:analysis / Q000737:chemistry
D001798:Blood Proteins; D015314:Dialysis Solutions; D007074:Immunoglobulin G; D012709:Serum Albumin; D000511:alpha-Macroglobulins; D001613:beta 2-Microglobulin