Is edema in minimal change disease of childhood really hypovolemic?
OBJECTIVE
In this study, we aimed to find out whether children with minimal change disease can be classified as hypervolemic by objective measures.


METHODS
Eighteen children with minimal change disease diagnosed at our department between November 2005 and May 2007 were included in this study. All patients were newly diagnosed or relapsed but were steroid free for at least 6 months. In the first week of edema and when edema resolved (5-7 days after initiation of therapy), weight, height and blood pressure were obtained from all patients. Serum and plasma samples were taken following a starvation period of 12-14 h. The volume load of all patients was evaluated, measuring the inferior vena cava indices in each stage by echocardiography.


RESULTS
Average weight at presentation was 8.5% higher than the ideal (dry) weight. There were significant differences between the first and post-treatment body weights, abdomen circumference, and systolic and diastolic blood pressure values (P<0.05 for each). The inferior vena cava index (IVCI) values decreased significantly after diuretic treatment (P<0.001), while inferior vena cava collapsibility index (IVCCI) values increased in the post-treatment period (P<0.001).


CONCLUSIONS
We believe that a close follow-up of hypervolemic children with MCD, treated solely with easy-to-handle diuretics instead of I.V. albumin and diuretics may properly solve the edematous state in these patients.
Tabel
Yilmaz
Y
Department of Pediatric Nephrology, Faculty of Medicine, Inonu University, Turgut Ozal Tip Merkezi, Cocuk Klinigi, 44280 Malatya, Turkey. yilmaztabel@yahoo.com
Mungan
Ilke
I
Karakurt
Cemsit
C
Kocak
Gulendam
G
Gungor
Serdal
S
D002648:Child; D002675:Child, Preschool; D004232:Diuretics / Q000627:therapeutic use*; D004487:Edema / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D020896:Hypovolemia / Q000150:complications* / Q000503:physiopathology; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications* / Q000503:physiopathology
D004232:Diuretics