Diagnostic Criteria for the Character of Generalized Edema in Pediatric Nephrotic Syndrome

摘要

The main complaint of patients with nephrotic syndrome (NS) is edema, but the pathogenesis of edema formation is the issue of ongoing controversy. In addition, it is clinically impossible to differentiate patients with severe nephrotic edema with intravascular volume expansion from patients with intravascular contraction. Therefore, despite the possibility of developing quite serious complications, there is a tendency using of albumin with diuretics for the treatment of generalized edema in pediatric practice. The hypoalbuminemia less than 15 g/l and sharply reduced fractional excretion of sodium less than 0.2% are characteristic for most children with nephrotic syndrome for the steroid-sensitive variant of the disease, which correlates with a decrease in renal blood flow and manifestations of the hypovolemic variant of hemodynamics. The expressed hypoalbuminemia (more than 15 g/l) and relatively high fractional excretion of sodium (more than 1.0%) are more characteristic for patients with steroid-resistant NS, which are combined with an increase in renal blood flow and the predominance of hypervolemia. Based on the correlation of hemodynamic parameters and renal sodium retention, we propose the reliable clinical and functional criteria for determining variants of edema syndrome with pathologic mechanisms by type of underfill (refractory edema) and overfill, when sodium retention is primary. This effectively determines the method of treating generalized edema, including infusion therapy with albumin or colloidal solutions on the background of forced diuresis, or use only diuretic therapy.