Utility of muscle ultrasound in nutritional assessment of children with nephrotic syndrome (original) (raw)
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Measuring nutritional status in children with chronic kidney disease 1–3
Children with chronic kidney disease (CKD) are at risk of proteinenergy malnutrition. Existing clinical practice guidelines recognize this and recommend specific methods to assess nutritional status in patients with CKD. This review summarizes the methods for nutritional assessment currently recommended in the United States for children with CKD and details the strengths and limitations of these techniques in the clinical setting. Dietary assessment, serum albumin, height, estimated dry weight, weight/height index, upper arm anthropometry, head circumference, and the protein equivalent of nitrogen appearance are reviewed. We also describe methods for body-composition assessment, such as dual-energy X-ray absorptiometry, bioelectrical impedance analysis (BIA), total body potassium, densitometry, and in vivo neutron activation analysis, pointing out some advantages and disadvantages of each. In CKD, fluid overload is the most important factor leading to misinterpretation of nutritional assessment measures. Abnormalities in the distribution of fat and lean tissue may also compromise the interpretation of some anthropometric measures. In addition, metabolic abnormalities may influence the results obtained by some techniques. Issues specific to evaluating nutritional status in the pediatric population are also discussed, including normalization of nutritional measures to body size and sexual maturity. We stress the importance of expressing bodycomposition measures relative to height in a population in whom short stature is highly prevalent.
Pediatric Nephrotic Syndrome; Clinical Characteristics and Nutritional Status
Al-Mukhtar Journal of Sciences, 2020
Nephrotic syndrome (NS), is the most common chronic renal disorder in children, with multifactorial risk factors and complex etiology. Therefore, the aim of the present study was to determine the age and gender distribution and also determine the clinical characteristics and nutritional status of pediatric nephrotic syndrome. A total of 75 patients with nephrotic syndrome series were selected through semi-constructed questionnaires. The age of our subjects ranged between 1-18 years. Body weight and height were extracted from patient files or self-reported to calculate BMI percentile. Laboratory tests such as blood glucose, lipid profile vitamin D, and HbA1C were included. All samples were analyzed through either mean ±SEM or Chi-square for determining significant differences. The present study showed that 75 patients were diagnosed as nephrotic syndrome. The average age of patients was 9 years old and the age which showed significance was 6-10 years (p=0.04). In comparison to female...
Research Square (Research Square), 2023
Background Nephrotic syndrome (NS) is one of the common paediatric renal diseases, primarily managed by steroid therapy. Steroid therapy is associated with signi cant complications, including reduction in the quality of life in these patients. However, there is lack of evidence addressing the physical function (PF) among children with NS. Therefore, this study aims to assess feasibility of PF evaluation in children with NS and to correlate with the steroid dosage. Methods A cross-sectional study included children aged 6 to 12 years diagnosed with NS receiving steroid therapy in the last 6 months. PF assessment included muscle strength (hand-grip strength-HGS), cardiorespiratory endurance (2 Minute Walk Test-2MWT) and exibility (Sit and Reach Test-SRT). Descriptive statistics and correlation with the steroid dosage (Mann-Whitney test) were performed using SPSS v.21. Results Study included 24 children (50% boys) with a mean age of 8.3years and BMI of (18.16 ± 3.63kg/m²). All three PF components i.e.,2MWT (155.7 ± 38.6m), HGS-boys(9.19 ± 4.08kgs),HGS-girls(8.54 ± 2.32kgs) and SRT(-7.36 ± 4.9cm)exhibited signi cant reduction in comparison with normative data (p < 0.05, CI 95%). There was no signi cant correlation between the cumulative steroid dose and PF in the last 6 months. Conclusion Children with NS have signi cant compromise in their physical function compared to normative data. The ndings of the study support the need for incorporating routine physical function assessment into the routine standard care protocols in these children.
Pediatric Nephrology
In children with kidney diseases, an assessment of the child’s growth and nutritional status is important to guide the dietary prescription. No single metric can comprehensively describe the nutrition status; therefore, a series of indices and tools are required for evaluation. The Pediatric Renal Nutrition Taskforce (PRNT) is an international team of pediatric renal dietitians and pediatric nephrologists who develop clinical practice recommendations (CPRs) for the nutritional management of children with kidney diseases. Herein, we present CPRs for nutritional assessment, including measurement of anthropometric and biochemical parameters and evaluation of dietary intake. The statements have been graded using the American Academy of Pediatrics grading matrix. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. Audit and research recommen...
Assessment of body composition in children with chronic renal failure
Pediatric Nephrology, 2000
In children with chronic renal failure treated conservatively by dialysis or by transplantation, various alterations of the nutritional, metabolic and fluid homeostasis may occur that may critically affect the patients' acute and chronic well-being. In the past, the assessment of body composition in children was hampered by insufficient precision, standardization and/or availability of appropriate anthropometric tools. Recently, there have been several methodological advances that may facilitate close and precise monitoring of body composition in this population. Specifically, the use of body mass index (BMI) data in children has become possible by the introduction of pediatric reference values processed for the calculation of standard deviation scores accounting for the skewed distribution of BMI. Skewness-adapted reference data have also been provided for percentage fat mass as assessed by multisite skinfold measurements. In addition, bioelectrical impedance analysis has been validated in healthy children as well as in pediatric dialysis and renal transplant populations. This novel auxological technique provides a highly reproducible, non-invasive and inexpensive way of assessing changes in total body water content in dialysed patients, as well as changes in fat and fat-free mass prior to dialysis and after renal transplantation.
Nutrition in Pediatric Nephrotic Syndrome
Journal of pediatric nephrology, 2017
Nephrotic Syndrome is a collection of symptoms due to glomerular damage, characterized by proteinuria ≥3.5g/day or a protein-creatinine ratio ≥2. From an etiological point of view, there are three forms of nephrotic syndrome, including congenital, primary, and secondary. The first sign of the disease is periorbital edema, especially in the morning. Diagnostic confirmation is done through evaluation of urine protein, serum electrolytes, BUN, Cr, Albumin, and cholesterol. The main treatment goals of nephrotic syndrome are decreasing proteinuria, preventing complications, and protecting the renal function via appropriate drugs and diet. The main objective of this study was to review diets required in nephrotic syndrome in children: Protein at a diose of 0.8 mg/kg/day is the most effective diet in nephrotic patients. Lowfat diets (calorie intake <30% and cholesterol ≤200mg/day) can improve hyperlipidemia. Salt and water intake should be restricted in the range of less than 2 gr/day and 1-1.5 liters/day, respectively. Nephrotic syndrome patients have iron, copper, zinc, and calcium deficiency due to increased urine protein excretion or concomitant metabolic disorders. Nephrotic syndrome, Diet, Pediatrics
Body composition and nutritional intake in children with chronic kidney disease
Pediatric Nephrology, 2006
The aim of this study was to assess body composition in children with chronic renal failure (CRF) and post renal transplantation (Tx), and to compare it to body mass index (BMI) and nutritional intake. Dietary assessment using 3-day diaries, total and regional body composition assessment by dual x-ray energy absorptiometry of 50 CRF children (29M, 21F), median age 8.9 yrs and 50 Tx children (32M, 18F), median age 12.9 yrs. BMI, percentage fat mass (%FM) and lean mass (LM) were corrected for height and expressed as SDS (HSDS). In both groups, BMIHSDS was lower than %FMHSDS and higher than LMHSDS (p<0.05). In the Tx group, there were associations on bivariate analysis between energy & protein intake and BMIHSDS & %FMHSDS (r,0.5, p<0.05), and between LMHSDS and protein intake (r,0.5, p<0.05). On multivariate analysis, there was an association between LMHSDS and time since transplantation (r,−0.4, p<0.05). Children in the CRF and Tx groups had a high percentage predicted trunk:leg FM ratio of 148% and 157%, respectively. Children with CRF and Tx have discordant body composition with a relatively high FM and low LM, which is not reflected by BMI. In addition, they appear to have an increased level of central adiposity that may predispose them to increased morbidity in later life. Keywords Chronic renal failure . Post-Renal Transplantation . Lean Mass . Fat Mass . DXA Abbreviations CRF chronic renal failure Tx post-renal transplantation BMI body mass index DXA dual X-ray energy absorptiometry rhGH Recombinant Growth Hormone FM fat mass LM lean mass HSDS height standard deviation scores DRV dietary reference values RNI reference nutrient intake ESRD end stage renal disease GFR glomerular filtration rate ppFR percentage predicted fat trunk:leg ratio BMC bone mineral content TBW total body water
PubMed, 2015
Background: Malnutrition is a major problem among children with Chronic Kidney Disease (CKD) and it is essential to be recognized as early as possible. Aim of our study was to assess the nutrition status of children with CKD. Methods: Nutrition status of 30 children (1-16 years) with CKD stages IIIV and on peritoneal dialysis was evaluated. Malnutrition risk was assessed by Pediatric Digital Scaled MAlnutrition Risk screening Tool (PeDiSMART) score software.Anthropometry was expressed as Z-scores for age and sex. Phase angle (PhA) and body cell mass were assessed by bioelectrical impedance analysis (BIA). Three-day food intake was recorded and analyzed. Biochemical indexes were assessed. Results: Depending on the marker used for assessment 20-40% of our patients were malnourished. Intake/requirements ratio (median) was 86.5% for actual energy intake and 127% for actual protein intake. Multiple regression analysis has shown that the most determinant factor for Mid Upper Arm Circumference (MUAMC) was actual protein intake, Glomerular Filtration Rate (GFR) and age at diagnosis. PhA was mainly affected by GFR and energy intake. Statistically significant inverse correlation was found between PeDiSMART score and PhA (p=0.001), MUAMC (p=0.008) as well as protein intake (p=0.016). Conclusions: A considerable proportion of children with advanced CKD are undernourished. Regular dietitian evaluation based on novel tools as PeDiSMART score and PhA may identify earlier patients at risk for malnutrition. Hippokratia 2014; 18 (3): 212-216.
Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis
P e r i t o n e a l D i a l y s i s I n t e r n a t i o n a l , V o l . 2 1 , p p . 1 7 2 -1 7 9 P r i n t e d i n C a n a d a . A l l r i g h t s r e s e r v e d . 0 8 9 6 -8 6 0 8 / 0 0 $ 3 . 0 0 + . 0 0 C o p y r i g h t © 2 0 0 1 I n t e r n a t i o n a l S o c i e t y f o r P e r i t o n e a l ♦ ♦ ♦ ♦ ♦ Objective: To evaluate the sensitivity of anthropometry and bioelectrical impedance analysis (BIA) in detecting alterations in body composition of children treated with peritoneal dialysis (PD), and to determine the prevalence of malnutrition in this population, in short-and long-term PD duration, using anthropometric and BIA-derived indices. ♦ ♦ ♦ ♦ ♦ Patients: Eighteen children treated with automated PD (11 males, 7 females; mean age 8.7 ± 4.7 years). ♦ ♦ ♦ ♦ ♦ Design: Eighteen patients were studied using anthropometry and BIA at the start (t0) and after 6 months (t1) of PD, 15 of these patients at 12 months (t2), and 8 at 24 months (t3) of PD. Midarm muscle circumference (MAMC), arm muscle area (AMA), and arm fat area (AFA) were calculated from anthropometric measures according to Frisancho (FrisanchoAR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 1981; 34:2540-5.). The bioelectrical measures of resistance (R) and reactance (Xc) were obtained directly from the impedance signal; phase angle (PA) and distance (D) were calculated using mathematical formulas. Nutritional status was assessed by anthropometric measurements and BIA-derived indices, expressed as standard deviation scores (SDS), and by a score system based on BIA and anthropometric parameters. The percentage of children with values of anthropometric and BIA-derived indices below the 3rd percentile or between the 3rd and 25th percentiles, and the percentage of children with scores of 7 -12 and 4 -6 were calculated in order to detect patients with severe or moderate derangement of nutritional status. ♦ ♦ ♦ ♦ ♦ Results: The mean SDS values of Xc, PA, and D significantly improved (p = 0.05, p = 0.001, p = 0.02) during the first 6 months of PD and remained almost stable during the following months. The SDS values of the anthropometric indices were less compromised than those of the BIA-derived indices, particularly at the start of dialysis. By 6 months, the percentages of children with values of BIA and anthropometric indices below the 3rd percentile had decreased. The percentages of patients with moderate and severe derangement of BIA and anthropometric indices remained substantially unchanged after 12 months. However, at 24 months, the percentage of patients with moderate derangement of BIA indices increased. All these findings were confirmed by the nutritional score system. ♦ ♦ ♦ ♦ ♦ Conclusion: BIA is more sensitive than anthropometry in detecting alterations in body composition of children on PD.
Muscle mass assessment in renal disease: the role of imaging techniques
Quantitative Imaging in Medicine and Surgery
Muscle wasting is a frequent finding in patients with chronic kidney disease (CKD), especially in those with end-stage kidney disease (ESKD) on chronic dialysis. Muscle wasting in CKD is a main feature of malnutrition, and results principally from a vast array of metabolic derangements typical of the syndrome, that converge in determining reduced protein synthesis and accelerated protein catabolism. In this clinical setting, muscle wasting is also frequently associated with disability, frailty, infections, depression, worsened quality of life and increased mortality. On these grounds, the evaluation of nutritional status is crucial for an adequate management of renal patients, and consists of a comprehensive assessment allowing for the identification of malnourished patients and patients at nutritional risk. It is based essentially on the assessment of the extent and trend of body weight loss, as well as of spontaneous dietary intake. Another key component of this evaluation is the determination of body composition, which, depending on the selected method among several ones available, can identify accurately patients with decreased muscle mass. The choice will depend on the availability and ease of application of a specific technique in clinical practice based on local experience, staff resources and good repeatability over time. Surrogate methods, such as anthropometry and bioimpedance analysis (BIA), represent the most readily available techniques. Other methods based on imaging modalities [dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging (MRI), and whole body computed tomography (CT)] are considered to be the "gold standard" reference methods for muscle mass evaluation, but their use is mainly confined to research purposes. New imaging modalities, such as segmental CT scan and muscle ultrasound have been proposed in recent years. Particularly, ultrasound is a promising technique in this field, as it is commonly available for bedside evaluation of renal patients in nephrology wards. However, more data are needed before a routine use of ultrasound for muscle mass evaluation can be recommended in clinical practice.