A descriptive retrospective study on children with newly diagnosed nephrotic syndrome presented to Tripoli Children Hospital during the period between Jan. to Dec. 2014

Introduction: Nephrotic syndrome is a clinical picture characterized by severe proteinuria, hypoalbuminemia, edema and hypercholesterolemia. A retrospective study was carried out in order to describe disease pattern in newly diagnosed nephrotic syndrome of children admitted to Tripoli children hospital during the year 2014.Methods: The medical data of 56 patients aged between 1 year and 11 years diagnosed with idiopathic nephrotic syndrome were analysed using SPSS software. The data included gender differences, sensitivity to steroid therapy, relapses during six months of follow up and the effect of variable factors such as family history, hypertension, hematuria, serum urea on the degree of relapse.Results: Out of 56 patients with newly diagnosed nephrotic syndrome (NS), 60.7% were boys and 39.3% were girls, with a mean age 4.2±2.2 years. Age was related significantly to the response to steroid therapy, where 79.5% of patients aged between 2-8 years (group 1) had steroid sensitive nephrotic syndrome (SSNS) compared with only 41.7% of patients aged less than 2 years or more than 8 years (group 2) (P<0.001). Although girls relapsed more than boys (70.5% versus 57.1%) during six months of therapy, this difference was not statistically significant. Similarly, no other factors measured such as family history of NS, hypertension, hematuria, serum complement and urea had any effect on the percentage of relapse in patients with newly diagnosed NS. Conclusion: NS is one of the commonest reasons for admission to nephrology ward. It is more common in boys than girls. The age at presentation related significantly to the response to steroidal therapy. Regarding relapses, girls seems to relapse more frequent than boys and relapses was seen more in age group 1 than group 2, however, these differences were not significant. Other factors studied seems to have no effect on the relapse rate of children with newly diagnosed NS

Mechanisms of Oedema: the Minor Role of Hypoalbuminaemia

Objectives: Seriously ill patients often suffer from disorders of salt and water balance and present with clinical signs of either dehydration or oedema. The relationship of hypoalbuminaemia to oedema is complex and controversial and formed the central issue of this study. Design: Prospective study Setting: Medical wards of New Somerset Secondary Hospital; November 2004. Subjects: 50 patients admitted consecutively to the medical wards at New Somerset Hospital were evaluated. 26 males and 24 females participated. Outcome measures:. An attempt was made to correlate causes of salt and water imbalance with the clinical assessment of volume status; oedema formation; nutritional state and serum albumin levels. Results: Hypoalbuminaemia was not related to oedema in this study. From the 24 patients with serum albumin below 30 g/L; only 6 had oedema. These patients all had other abnormalities which could have resulted in the oedema: notably primary salt retention by failing kidneys; cor pulmonale and malignan- cy. None of the patients with serum albumin levels below 15 g/L had any signs of oedema. The combined insult of a chronic inflammatory disease and malnutrition had a marked effect on serum albumin levels. Conclusion: Significant hypoalbuminaemia was present in a substantial portion of the patients included in this study; yet oedema was detected infrequently and generally had an easily identifiable cause not related to low albumin levels. Most patients with hypoalbuminaemia presented with normal or positive water balance. This study supports the notion that hypoalbuminaemia is infrequently associated with oedema and plays a minor role in its formation

Hypoalbuminaemia in brain-dead donors for liver transplantation: transplantation

Liver transplantation has become established as the treatment of choice for most patients with end-stage liver disease and is performed on a routine basis in most major centres throughout the world. The majority of donors for liver transplantation are brain-dead cadaver donors following either a severe head injury or a massive intracranial haemorrhage. Potential liver donors undergo a rigid screening process before being accepted. This includes a thorough clinical examination to assess the haemodynamic status of the donor and to exclude any overt evidence of liver disease. Blood samples are also taken for viral studies to exclude HIV infection and hepatitis B and C infection; and for liver function tests to exclude liver disease or liver injury. Over the years we have noted that our liver donors often had low serum albumin levels; although this has not been formally documented. A review of the literature revealed that hypoalbuminaemia associated with severe head injury has been documented previously. However the impact of brain death on serum albumin levels has not been studied previously. The present study was therefore undertaken to document serum albumin levels in brain-dead cadaver donors