Perspectives on edema in childhood nephrotic syndrome.
There have been two major theories surrounding the development of edema in nephrotic syndrome (NS), namely, the under- and overfill hypotheses. Edema is one of the cardinal features of NS and remains one of the principal reasons for admission of children to the hospital. Recently, the discovery that proteases in the glomerular filtrate of patients with NS are activating the epithelial sodium channel (ENaC), resulting in intrarenal salt retention and thereby contributing to edema, might suggest that targeting ENaC with amiloride might be a suitable strategy to manage the edema of NS. Other potential agents, particularly urearetics and aquaretics, might also prove useful in NS. Recent evidence also suggests that there may be other areas involved in salt storage, especially the skin, and it will be intriguing to study the implications of this in NS.
Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Chia Wei
CW
Teoh
Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Lisa A
LA
Robinson
Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada damien.noone@sickkids.ca.
Damien
D
Noone
D002648:Child; D004232:Diuretics / Q000627:therapeutic use; D004487:Edema / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*; D053503:Epithelial Sodium Channels / Q000378:metabolism; D006801:Humans; D009404:Nephrotic Syndrome / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*; D012964:Sodium / Q000378:metabolism
D004232:Diuretics; D053503:Epithelial Sodium Channels; D012964:Sodium
ENaC; aquaretic; edema; nephrotic syndrome; urearetic