Dedi Rachmadi
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Padjadjaran-Rumah Sakit Dr. Hasan Sadikin Bandung

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Hemodialysis in Children with Chronic Kidney Disease

Journal of the Indonesian Medical Association Vol. 59 No. 11 November 2009
Publisher : Journal of the Indonesian Medical Association

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Abstract

Patient with Chronic Kidney Disease (CKD) may have acute exacerbation symptoms, which can be seen as acute worsening of renal function. This condition is an emergency case and need prompt acute dialytic treatment. Acute peritoneal dialysis remains a viable option for the dialytic treatment in children, particularly those who are hemodynamically compromised. Hemodialysis is use when contra indications of peritoneal dialysis are found or when peritoneum membran is less efective like in peritonitis. This case report a hemodialisis treatment in children with acute exacerbation of CKD. A boy, 13 years old came to Hasan Sadikin general hospital with the chief complaint was difficulty of breathing, which was accompanied by pale, head aches, vomiting, and blurred vision. There was history of edema anasarca, hypertension, and colacolored urine in 3 years ago. Physical examination revealed established hypertension, kussmaul breathing, anemia, hypervolemia sign (cardiomegaly, pulmonary edema). From, the laboratory examination, anemia, thrombocytopenia, hyperkalemia, hyponatremia, metabolic acidosis, increased ureum 383 mg/dL, creatinin 21.44 mg/dL, and proteinuria, leucocyturia, microscopic hematuria in urinalysis were found. Chest x ray showed cardiomegaly, and pulmonary edema. USG of kidney found chronic process of both kidney. We performed an acute peritoneal dialisys to overcome the acute exacerbation. Since the patient had peritonitis, the treatment was changed to hemodialysis. Further assessment revealed CKD grade 5 (end stge renal disease) and the management followed by chronic hemodialysis before kidney transplantation performed.Keywords: chronic kidney disease, hemodialysis in children

Correlation between Body Mass Index and Blood Pressure in Ethnic Malay and Chinese Children

Journal of the Indonesian Medical Association Vol. 62 No. 6 June 2012
Publisher : Journal of the Indonesian Medical Association

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Abstract

Introduction: Along with increasing number of obese children, the prevalence of hypertension is also increasing. Factors known to have role in children’s blood pressure include weight, age, gender, life style, family history of hypertension, stress and ethnicity. This study was made to determine the correlation between body mass index (BMI) and blood pressure and to find out the difference in blood pressure between ethnic Malay and Chinese children in regards to BMI.Method: An analytic study using cross-sectional design was conducted in several elementary schools in Bandung. Correlation between BMI and blood pressure was analyzed using Pearson correlation test. Regression analysis was performed to see the difference in BMI and blood pressure relationship between the two groups. A total of 154 ethnic Malay children and 150 ethnic Chinese children were the subjects of this study.Result: Significant correlation existed between BMI and systolic blood pressure within Malay and Chinese ethnic groups (r=0.673, p<0.001 and r=0.688, p<0.001).  Systolic blood pressure in regards to BMI was higher in Malay group compared to Chinese group.Conclusion: Blood pressure was correlated to BMI in both groups, while the value of systolic blood pressure in regards to BMI is higher in ethnic Malay group compared to ethnic Chinese group.Key words: body mass index, blood pressure, ethnicity

Aspek Genetik Sindrom Nefrotik Resisten Steroid

Majalah Kedokteran Bandung Vol 42, No 1 (2010)
Publisher : Fakultas Kedokteran, Universitas Padjadjaran

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Abstract

Sindrom nefrotik resisten steroid adalah sindrom nefrotik yang tidak mengalami remisi setelah diberikan terapi standar steroid. Sampai saat ini mekanisme resistensi terhadap steroid melalui dua hal, yaitu nongen yang berkaitan erat dengan dasar imunologis dan gen yang berupa defek primer pada barier filtrasi glomerulus. Dalam tulisan ini akan diungkapkan gen yang sudah diketahui terlibat dalam patogenesis terjadinya sindrom nefrotik resisten steroid. Gen ini menyandi protein yang membentuk struktur celah diafragma glomerulus. Bila terjadi mutasi gen ini akan mengakibatkan perubahan pada arsitektur celah diafragma glomerulus, yaitu terjadi pendataran foot processes podosit sehingga terjadi proteinuria berat. Sampai saat ini telah ditemukan delapan gen penyandi protein podosit, yaitu: NPHS1, ACTN4, NPHS2, CD2AP, WT1, TRPC6, LAMB2, dan yang paling ahir diketahui yaitu NPHS3. Protein yang disandi oleh gen-gen tersebut adalah: nefrin, á-aktinin-4, podosin, CD2-associated protein, Wilms tumor, transient receptor potential 6, laminin â2 chain, dan phospholipase PLCE1. Manifestasi klinis sindrom nefrotik resisten steroid akibat adanya mutasi gen-gen ini umumnya lebih berat, onset terjadinya penyakit lebih awal, dan cepat mengalami perburukan menjadi gagal ginjal terminal. Aspek genetis sindrom nefrotik resisten steroid perlu diketahui untuk memperkirakan perjalanan dan prognosis penyakitGenetic Aspect of Steroid Resistant Nephrotic SyndromeSteroid resistant neprotic syndrome are patients who showed no remission after standard therapy of steroid. Until now, steroid resistant mechanism occurs through two ways, that are non gene that related with immunologic based and gene related with primary defect on glomerular filtration barrier. This paper describes those genes known relate to the pathogenesis of steroid resistant nephrotic syndrome. These genes code glomerular slit diaphragm proteins. Mutation of these genes will cause changes on glomerular slit diaphragm architecture that is flattening of foot processes of podocyte which cause severe proteinuria. Recently, there are found 8 genes that code podocyte proteins:NPHS1, ACTN4, NPHS2, CD2AP, WT1, TRPC6, and LAMB2, last found is NPHS3 gene. Proteins coded by those genes are: nefrin, á-actinine-4, podosine, CD2-associated protein, Wilms tumor, transient receptor potential 6, laminin â2 chain, and phospholipase PLCE1. Clinical manifestation of steroid resistant nephrotic syndrome caused by mutation of these genes generally severe, earlier onset of illness and worsen to end stage kidney failure. We need to know about genetic aspect of steroid resistant neprotic syndrome to predict the progression and prognosis of the disease.

Mutasi Gen NPHS2 (412C→T, 419delG) dan Manifestasi Klinis Sindrom Nefrotik Resisten Steroid Anak Indonesia

Majalah Kedokteran Bandung Vol 43, No 4 (2011)
Publisher : Fakultas Kedokteran, Universitas Padjadjaran

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AbstrakSindrom nefrotik resisten steroid (SNRS) karena mutasi gen nephrotic syndrome type 2 (NPHS2) mempunyai manifestasi klinis lebih berat dibandingkan dengan SNRS tanpa mutasi gen. Penelitian ini bertujuan untuk mengetahui mutasi gen NPHS2 (412C→T, 419delG) pada SNRS anak Indonesia dan melihat perbedaan manifestasi klinisnya. Penelitian ini berupa observasional potong silang pada 88 penderita SNRS yang diambil secara consecutive admission dari 10 rumah sakit pendidikan di Indonesia, periode September 2006–Desember2007. Analisis mutasi 412C→T dan 419delG diperiksa dengan polymerase chain reaction. Analisis statistik menggunakan multivariat dan uji chi-square. Dari 88 SNRS didapat 58 (66%) mutasi 412C→T dan 69 (78%) mutasi 419delG. Hasil analisis multivariat variabel interval manifestasi klinis (tekanan darah sistol dan diastol, kadar kreatinin serum, usia serangan pertama, dan pertumbuhan) antara kelompok mutasi gen 412C→T, 419delG dan kelompok tanpa mutasi gen didapatkan masing-masing F=0,316; p=0,902 dan F=0,651; p=0,662. Hasil analisis univariat dari variabel nominal manifestasi klinis sebagai berikut: hematuria, p=0,231(0,726); hipertensi, p=0,286 (0,741); usia serangan pertama, p=0,372 (0,304); pertumbuhan skor Z, p=0,087 (0,595), dan kreatinin serum p=0,049 (0,080). Tidak terdapat perbedaan manifestasi klinis antara penderita SNRS dengan mutasi genNPHS2 (412C→T, 419delG) dan penderita SNRS tanpa mutasi gen, kecuali kadar kreatinin serum pada penderita SNRS dengan mutasi gen 412 C→T. [MKB. 2011;43(4):193–8].Kata kunci: Manifestasi klinis, mutasi gen NPHS2 (412C→T, 419delG), sindrom nefrotik resisten steroid NPHS2 (412 C→T and 419delG) Gene Mutation and Their Clinical Manifestation in Indonesian Steroid-Resistant Nephrotic SyndromeSteroid resistant nephrotic syndrome (SRNS) due to nephrotic syndrome type 2 (NPHS2) gene mutation has more severe clinical manifestation than those without mutation. This study was designed to find NPHS2 gene mutation in 412C→T and 419delG in Indonesian SRNS and to see differences in clinical manifestation. The observational cross sectional study was performed on 88 SRNS. Subjects were taken consecutively from 10 teaching hospitalsin Indonesia during September 2006 to December 2007. Analysis for 412 C→T and 419delG mutations were examined by polymerase chain reaction. Multivariate and chi-square-test analysis were used. Of 88 SNRS, 58 (66%) with 412 C→T and 69 (78%) with 419delG mutations. Multivariate analyses for interval variable of clinical manifestations (systolic and diastolic blood pressure, serum creatinin level, age of onset and growth) between SRNS with NPHS2 412C→T, 419delG mutation and SRNS without mutation were F=0.316, p=0.902 and F=0.651, p=0.662, respectively. While univariate analyses for nominal variable of clinical manifestation were as follow: hematuria, p=0.231 (0.726); hypertension, p=0.286 (0.741); age of onset, p=0.372 (0.304); Z-score growth, p=0.087 (0.595) and serum creatinin, p=0.049 (0.08). There is no difference of clinical manifestation between SRNS with NPHS2 412C→T, 419delG mutation and SRNS without mutation, except on serum creatinin in 412C→T mutation. [MKB. 2011;43(4):193–8].Key words: Clinical manifestation, NPHS2 (412C→T, 419delG) gene mutation, steroid resistant nephroticsyndrome

Hubungan Kadar Seng Plasma dengan Derajat Penyakit Pneumonia

Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pneumonia merupakan masalah kesehatan utama anak di dunia dan sebagai penyebab terbanyak morbiditas dan mortalitas anak di negara berkembang. Anak dengan defisiensi mikronutrien termasuk seng berisiko tinggi terjadi pneumonia, karena gangguan sistem imun. Penelitian ini bertujuan mengetahui hubungan kadar seng plasma dengan pneumonia, pneumonia berat, dan sangat berat pada anak usia 2–59 bulan. Penelitian observasi analitik dengan rancangan potong lintang dilakukan bulan Agustus sampai November 2009 di Departemen Ilmu Kesehatan Anak RS Dr. Hasan Sadikin Bandung, RS Ujung Berung, dan RS Cibabat. Subjek harus memenuhi kriteria diagnosis klinis pneumonia menurut World Health Organization (WHO) Indonesia dan berusia 2–59 bulan. Pengambilan sampel darah untuk pemeriksaan kadar seng plasma dilakukan saat penderita datang. Analisis data menggunakan uji eksak Fisher dan untuk melihat hubungan kadar seng plasma dengan derajat pneumonia menggunakan uji Mann-Whitney. Dari total 42 subjek yang memenuhi kriteria inklusi, didapatkan 1 (2%) anak pneumonia, 32 (76%) pneumonia berat, dan 9 (22%) pneumonia sangat berat. Terdapat perbedaan bermakna (p=0,032) kadar seng plasma antara kelompok pneumonia berat dan sangat berat dengan median 96,685 μg/dL (57,32–195,66 μg/dL) untuk penumoia berat dan 80,240 μg/dL (63,01–111,84 μg/dL) untuk pneumonia sangat berat. Penelitian ini menunjukkan bahwa bahwa kadar seng plasma memiliki hubungan dengan pneumonia berat dan sangat berat pada anak usia 2–59 bulan. [MKB. 2012;44(4):213–17].Kata kunci: Pneumonia, seng plasma, sistem imun Association Plasma Zinc Level with Severity of PneumoniaPneumonia is a major health problem affecting children all over the world and remains a major cause of childhood morbidity and mortality in developing countries. Children with micronutrients deficiency including zinc, which might cause immune system disorder, have higher risk to have pneumonia. The aim of this study was to investigate the association between plasma zinc level and pneumonia, severe, and very severe pneumonia in children aged 2–59 months. This observational analytic with cross-sectional study was performed at the Pediatric Department of Dr. Hasan Sadikin General Hospital, Ujung Berung Hospital and Cibabat Hospital, in August to November 2009. Subjects of this study were 2–59-month-old children who meet the WHO Indonesian classification for pneumonia. Blood samples for plasma zinc examination were collected on admission. Data were analysed using exact Fisherand Mann-Whitney test for the association between plasma zinc level and severity of pneumonia. A total of 42 subjects were enrolled, 1 (2%) child were classified as having pneumonia, 32 (76%) children with severe, and 9 (22%) with very severe pneumonia. There were significant differences (p=0.032) in plasma zinc levels between severe and very severe pneumonia with a median of 96.685 μg/dL (57.32–195.66 μg/dL) for severe pneumonia and 80.240 μg/dL (63.0–111.84 μg/dL) for very severe pneumonia. This study shows an association between plasma zinc levels and severe and very severe pneumonia in children aged 2–59 months. [MKB. 2012;44(4):213–17].Key words: Pneumonia, plasma zinc, immune system DOI: http://dx.doi.org/10.15395/mkb.v44n4.177

Perbedaan Myocardial Performance Index-Tissue Doplpler Imaging Ventrikel Kanan pada Bayi Kurang Bulan dan Bayi Cukup Bulan

Sari Pediatri Vol 13, No 2 (2011)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Abstract

Latar belakang.Bayi kurang bulan merupakan masalah di negara maju maupun negara berkembang. Pada bayi kurang bulan tahanan vaskular paru masih tinggi, sehingga tekanan di ventrikel kanan tinggi. Pengukuran fungsi ventrikel kanan sulit dilakukan dengan ekokardiografi standar karena bentuk geometri ventrikel kanan yang berbentuk “bulan sabit” dan trabekuler yang kasar.Myocardial performance index tissue doppler imaging (MPI-TDI) adalah cara pengukuran fungsi ventrikel kanan yang baru dikembangkan, merupakan penilaian fungsi ventrikel kanan pada fetus, anak, dan dewasa dengan berbagai penyakit jantung. Tujuan.Menilai apakah MPI-TDI pada bayi cukup bulan lebih tinggi dibandingkan dengan kurang bulan dan bagaimana korelasi antara MPI-TDI dan usia kehamilan.Metode.Penelitian dilakukan terhadap 36 bayi (17 bayi kurang bulan dan 19 bayi cukup bulan), berusia kehamilan 33–42 minggu, yang menjalani pemeriksaan MPI-TDI dengan menggunakan ekokardiografi, di Instalasi Pelayanan Jantung RS Dr. Hasan Sadikin periode Juli–Oktober 2010 dengan rancangan potong lintang. Analisis statistik yang digunakan adalah one wayANOVA untuk menilai perbedaan MPI-TDI bayi cukup bulan dan kurang bulan serta uji korelasi rankSpearman untuk menilai korelasi antara MPI-TDI dan usia kehamilan dengan kemaknaan hasil uji bila didapatkan p<0,05.Hasil.Didapatkan rerata MPI-TDI untuk bayi usia kehamilan <34 minggu adalah 0,31 (0,03), bayi usia kehamilan 34–36 minggu 0,32 (0,03) dan bayi usia kehamilan >37 minggu adalah 0,30 (0,03) (p=0,03). Nilai korelasi antara MPI-TDI dan usia kehamilan adalah (0,24) dengan nilai p=0,378. Kesimpulan.Didapatkan perbedaan MPI-TDI ventrikel kanan antara bayi kurang bulan dan cukup bulan. Tidak ada korelasi antara MPI TDI dan usia kehamilan.

Perbedaan Kadar Leptin pada Anak yang Menderita Infeksi Dengue

Sari Pediatri Vol 15, No 1 (2013)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Latar belakang. Infeksi dengue merupakan infeksi akut yang dapat mempengaruhi kadar leptin. Perbedaan spectrum klinis infeksi dengue menyebabkan perbedaan kadar interleukin-6 (IL-6) dan tumor necrosis factor-α(TNF-α). Tujuan. Mengetahui perbedaan kadar leptin pada anak yang menderita infeksi dengue.Metode.Penelitian analitik dengan rancangan potong lintang. Subjek penelitian adalah pasien DB, DBD, dan SSD (pascasyok) yang memenuhi kriteria klinis dan telah dibuktikan melalui pemeriksaan serologis. Analisis data menggunakan uji Kruskal Wallis dan Mann-Whitney untuk menentukan perbedaan kadar leptin pada DB dengan DBD dan SSD.Hasil. Pasien infeksi dengue 48 anak terdiri dari 27 DB, 11 DBD, dan 10 SSD. Terdapat perbedaan bermakna kadar leptin antara DB dengan DBD, dan SSD p=0,002. Rerata kadar leptin pada DD 703,4 (374,1–3616,7), DBD 2.172 (554,3–16631,1), dan SSD 1.321 (250,5–4.714,6). ng/mL Kadar leptin DBD lebih tinggi dibandingkan dengan DD (p<0,001), namun kadar leptin antara DBD dan SSD tidak berbeda bermakna (p=0,132) dan kadar leptin antara SSD (postsyok) dan DD tidak berbeda bermakna (p=0,158).Kesimpulan. Kadar leptin pada DBD lebih tinggi dibandingkan dengan DD, sedangkan kadar leptin antara DBD dan SSD (postsyok) tidak berbeda.

Hubungan Usia, Jenis Kelamin, Pendidikan Orangtua, Status Sosioekonomi Keluarga, dan Dosis Kumulatif Prednison dengan Masalah Psikososial Pasien Sindrom Nefrotik Idiopatik

Sari Pediatri Vol 15, No 6 (2014)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

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Latar belakang. Sindrom nefrotik idiopatik (SNI) merupakan penyakit kronik yang memerlukan pengobatan steroid jangka panjang. Pada penyakit kronik lain telah diteliti pemberian steroid jangka panjang dan faktor yang berpengaruh terhadap terjadinya masalah psikososial.Tujuan. Menganalisis hubungan faktor usia, jenis kelamin, tingkat pendidikan orangtua, status sosioekonomi, dan dosis kumulatif prednison dengan terjadinya masalah psikososial.Metode. Penelitian cross sectional dilaksanakan dari Januari 2013 sampai Mei 2013 melibatkan 26 subjek. Masalah psikososial dinilai dengan kuesioner Pediatric Symptom Checklist (PSC)-17. Analisis statistik dengan uji chi-square dan regresi logistik ganda.Hasil. Terdapat 13 dari 26 subjek mengalami masalah psikososial. Hasil analisis bivariabel mendapatkan usia 10-14 tahun RP 2,56 (IK95% 1,16−5,64); p=0,016, jenis kelamin perempuan RP 2,86 (IK 95% 1,02−8,04); p=0,016, pendidikan dasar orangtua RP 3,60 (IK 95% 1,50-8,62); p=0,004, status sosioekonomi keluarga rendah RP 1,25 (IK95% 0,54−2,89); p=0,001, dan dosis kumulatif prednison ≥3.640 mg RP 4,714 (IK 95% 1,292−17,201); p=0,002. Analisis multivariabel didapatkan usia RP 25,17 (IK95% 1,01-629,71); p=0,050, sosioekonomi RP 7,80 (IK95% 1,26-48,50); p=0.032, dan dosis kumulatif prednison RP 39,34 (IK 95% 1,89-818,93); p=0,018.Kesimpulan. Faktor usia, jenis kelamin, tingkat pendidikan orangtua, status sosioekonomi, dan dosis kumulatif prednison berhubungan dengan masalah psikososial pasien SNI. Dosis kumulatif prednison merupakan faktor paling dominan terhadap terjadinya masalah psikososial pasien SNI.

A Study of Hypoalbuminemia and Pleural Effusionin Pediatric Nephrotic Syndrome

Althea Medical Journal Vol 4, No 2 (2017)
Publisher : Althea Medical Journal

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Background: Nephrotic syndrome (NS) is a kidney disease that is most often found in children. Hypoalbuminemia in NS can cause a decrease in oncotic pressure causing extravasation of fluid into the interstitial space. In conditions of severe hypoalbuminemia, fluid extravasation may cause occurrence of pleural effusion. The objectives of this study was to analyze the correlation between hypoalbuminemia and pleural effusion in children with NS. Methods: An analytical study was conducted on 69 medical records of pediatric nephrotic syndrome from 1 January 2008–31 December 2013 in dr. Hasan Sadikin General Hospital. Inclusion criteria were pediatric patients between 1-14 years old with NS. Exclusion criteria were patients who already had albumin transfusion, malnutrition, patients with chronic disease, and incomplete medical record information. Contingency coefficient test was carried out to discover the correlation between variables. Results: Out of 89 samples, 69 samples were included. Characteristics of the included patients are male (n=48), female (n=21), age 1–5 (n=24), 6–10 (n=22), 11–14 (n=23), mild hypoalbuminemia (n=3), moderate hypoalbuminemia (n=27), severe hypoalbuminemia (n=39), patients with pleural effusion (n=23), and non-pleural effusion (n=46). There was a significant correlation between  hypoalbuminemia and pleural effusion with p=0.000 (p<0.05) and moderate correlation (r=0.437). Conclusions: Hypoalbuminemia has correlation with pleural effusion in pediatric nephrotic syndrome.Keywords: Hypoalbuminemia, pediatric nephrotic syndrome, pleural effusionDOI: 10.15850/amj.v4n2.1075

A Study of Hypoalbuminemia and Pleural Effusionin Pediatric Nephrotic Syndrome

Althea Medical Journal Vol 4, No 2 (2017)
Publisher : Althea Medical Journal

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Abstract

Background: Nephrotic syndrome (NS) is a kidney disease that is most often found in children. Hypoalbuminemia in NS can cause a decrease in oncotic pressure causing extravasation of fluid into the interstitial space. In conditions of severe hypoalbuminemia, fluid extravasation may cause occurrence of pleural effusion. The objectives of this study was to analyze the correlation between hypoalbuminemia and pleural effusion in children with NS. Methods: An analytical study was conducted on 69 medical records of pediatric nephrotic syndrome from 1 January 2008–31 December 2013 in dr. Hasan Sadikin General Hospital. Inclusion criteria were pediatric patients between 1-14 years old with NS. Exclusion criteria were patients who already had albumin transfusion, malnutrition, patients with chronic disease, and incomplete medical record information. Contingency coefficient test was carried out to discover the correlation between variables. Results: Out of 89 samples, 69 samples were included. Characteristics of the included patients are male (n=48), female (n=21), age 1–5 (n=24), 6–10 (n=22), 11–14 (n=23), mild hypoalbuminemia (n=3), moderate hypoalbuminemia (n=27), severe hypoalbuminemia (n=39), patients with pleural effusion (n=23), and non-pleural effusion (n=46). There was a significant correlation between  hypoalbuminemia and pleural effusion with p=0.000 (p<0.05) and moderate correlation (r=0.437). Conclusions: Hypoalbuminemia has correlation with pleural effusion in pediatric nephrotic syndrome.Keywords: Hypoalbuminemia, pediatric nephrotic syndrome, pleural effusionDOI: 10.15850/amj.v4n2.1075