Abstract
Inability to increase fractional excretion of filtered sodium (FENa) after sodium loading has been demonstrated in experimental AGN. Adult patients with AGN show FENa below 1.0. Since early changes in renal sodium handling in children with AGN are lacking, we studied 41 patients with post-streptococcal AGN (3 to 12 yrs. old). They all had hypertension with no previous treatment. The following urine-to-plasma ratio (UP) indices were studied: urea, osmolality, sodium, creatinine (Cr), and FENa. Patients were distributed into 3 groups: (I): 1-5 days of evolution, 18 cases; (II): 6 to 10 days, 15 cases; (III): 11 to 15 days, 8 cases. FENa in I was below 1.0 (x = 0.29 ± 0.39); most cases of II and III were above 1.0(x = 1.0 ± 0.7 and 1.6 ± 1.1 respectively; p < 0.01 between I and II and I and III). UPCr and UCr were: I) 245 ± 170 and 236 ± 144; 11) 61 ± 37 and 67 ± 50; III) 69 ± 70 and 62 ± 54 (p < 0.01 between I and 11 and I and III). No difference of age, sex and the other indices between the 3 groups were found. Our results show progresive increase of FENa in relation with time of evolution, depending on UCr changes. Early higher values of UCr suggest a temporary compensatory increase of glomerular filtration rate, probably secondary to hypervolemia. Hypervolemia might be produced by initial hemodynamic changes resulting from glomerular injury.
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