Nutritional assessment of nephrotic children

ABSTRACT

Nephrotic children are prone to develop malnutrition and growth retardation. Hence, the importance of nutritional assessment for such patients is clearly evident. The objectives of this study were to predict the most reliable parameters for such assessment, and to calculate the nitrogen balance for such patients. Nutritional status was assessed, in 23 nephrotic children whose ages ranged from 2 to 14 years, using relevant data derived from through clinical examination, appropriate laboratory investigations, as well as some specific calculations. The same assessment was conducted for 30 normal healthy age-matched children serving as a control group. Nephrotic children, compared to the control group, exhibited a statistically significant decrease regarding the height for age z score, the height for age percentile, the mid-arm circumference, the triceps skin fold thickness, the hemoglobin percentage, the red blood cell count, the white blood cell count, the circulating lymphocyte percentage, the serum protein level, the serum albumin level, and the blood urea nitrogen level. On the other hand, nephrotic children, compared to the control group, had a statistically significant increase in the plasma cholesterol level, the 24 hour urinary volume, the 24 hour urinary protein level, the 24 hour urinary urea level, the urinary protein/urinary creatinine ratio, and the creatinine clearance/urinary creatinine ratio. The nitrogen balance was positive in all the control group, while, it was negative in 78.3% [18 out of 23] nephrotic children. The latter correlated negatively with the circulating lymphocyte percentage, and positively with the 24 hour urinary urea level. It was concluded that nephrotic children were very prone to develop malnutrition and negative nitrogen balance. Both the mid-arm circumference, and the triceps skin fold thickness were valuable tools for nutritional assessment of such sick children. Measuring the circulating lymphocyte percentage, and the 24 hour urinary urea level might give a preliminary clue to the presence of a negative nitrogen balance