Effects of the Zinc Sulphate in a Girl with Chronic Renal Failure-Juniper Publishers
Juniper Publishers-Journal of Pediatrics
Introduction
End-stage renal disease (ESRD) is associated with
numerous complications, which may partly result from excessive amounts
of reactive oxygen species and/or decreased antioxidant activity [1]. In
children in haemodialysis have been described hipozincemia. Given the
diverse array of biologic functions of zinc, it is not surprising that
multiple physiological and metabolic functions, such as physical growth,
immunocompetence, reproductive function, and neurobehavioral
development are all affected by zinc status [2]. When the supply of
dietary zinc is insufficient to support these functions, biochemical
abnormalities and clinical signs may be developed [3].
Objectives
Inside of a study of evaluation of the effect of
administration of zinc sulphate on nutritional status in children with
chronic renal failure, we described a girl’s nutritional status.
Material and Methods
The study in 48 children with chronic renal failure
was controlled, concurrent, randomized and open (not masked), conducted
in two phases: Phase I: Baseline nutritional status diagnosis. Two
months: monthly anthropometric assessment (10 indicators) and
biochemical analysis (3 indicators). Phase II: Twelve months. For
restrictive randomization were assigned to group A (sulphate 30mg
Zn/day) or B (15mg Zn/day). Group B was a control group and the dose of
15 mg Zn/day as the minimum daily requirement of zinc. Were followed
monthly anthropometric
and biochemical analysis in the last month. We obtained serum levels of
C-reactive protein (marker of infection), albumin (visceral protein
reserve) and serum zinc. Anthropometric assessments of weight (W),
height (H), mid-arm circumference (MAC) and triceps skinfold thickness
(TSF) were used to develop the indicators: weight for age (W/A), height
for age (H/A), weight for height (W/H), nutritional index (IN), body
mass index (BMI), mid-arm muscle area (MAMA) or lean mass (LM), fat mass
(FM) and growth rate (GR). To diagnoses zinc deficiency we use serum
zinc > 70 μg/dl. The statistics test used was the nonparametric test
of Wilcoxon signed ranks [4].
Results
From the 13 indicators of nutrition, we obtained an
average of 0.78% of obese, a 36.45% of normal and a 59.64% of
malnourished children in the first evaluation. After oral administration
of zinc remained half of 1.04% of obesity, eutrophication of a 27.06%
of normal and 43.49% of malnutrition. There were 25% and 20.84% of
hipozincemia in the first and second biochemical evaluation,
respectively. With 30 mg/day of zinc sulphate, there was a significant
change in the nutritional index (p=0.025), the body mass index (p=0.009)
and in arm circumference (p=0.041). This increase in body mass was
significant in the age group under 14 years, with doses of 30 mg/day,
evidenced through the body mass index (p=0.26) and the arm circumference
(p=0.039).
One girl who was 10 years old, which have renal
failure by chronic interstitial nephritis with chronic malnutrition and
osteodystrophy. She could not walk when she started the study she needed
to help from her family to move around the house,
hospital and other places. When she started she was W/A -3.6,
H/A -4.9, W/H -2.1, BMI -1.6, MAMA -2, LM<5 percentile, FM<5
percentile and GR -3.9. Also, slow albumin, high PCR and normal
serum zinc. She entered in the group A and take sulphate 30mg
Zn/day pills for eleven month. Then she finished with W/A -3.6,
H/A -5.8, W/H -1.7, BMI -1.4, MAMA -2.2, LM <5 percentile, FM
< 5 percentile and GR -5.3, and slow albumin, normal PCR and
zinc deficiency. We can see that she improve W/H, BMI and PCR.
However, the best improve was in the end of the study, she can
walk alone by herself.
Discussion
Zinc is an essential metal for human body and it is necessary
for grow and development of children from pregnant women
since adult inclusive ancient. It is possible because zinc is a
dietary essential trace element, is primarily an intracellular metal
involved in numerous metabolic processes, i.e., as a catalyst,
structural element, or regulatory ion. With zinc deficiency,
multiple nonspecific general shifts in metabolism and function
occur, including reductions in growth, increased infections, and the
appearance of skin lesions [5]. In low-income countries like Peru,
where zinc intakes are inadequate, these functional disturbances
are often associated with impaired growth, increase risk of child
morbidity and mortality and preterm births.
All cells appear to have a small zinc reserve “stored” in
lysosomes [6,13]. However, some tissues, possibly bone, may
have labile zinc pools than can be redistributed to maintain zincdependent
functions in other tissues [7,13]. Bone contains ~30%
of total body, zinc, that is, ~700mg total or 66μg/g body weight,
with some differences due to sex (8, Bond). Studies showed that
bone zinc, as well as liver zinc, is mobilized when animals are fed a
zinc-deficient diet [9,13]. Because the total content of zinc in bone
is 3-fold higher than that of all soft tissues combined, a decrease
in bone zinc concentration would indicate a major release of
endogenous zinc compared with that from other tissues. Thus,
bone zinc may provide a “back-up” source of zinc for other tissues
with a vital zinc requirement when the dietary supply is inadequate
(10, bond). Nevertheless, there are important biological roles for
zinc in bone [13].
The change of a child with renal failure in dialysis who cannot
walk alone without modification her treatment with an exception
of 30mg/day of sulphate zinc supply. After eleven months she
can walk by herself could be, explain for the zinc function in all
bone of the body via zinc’s active role in collagen formation in the
epitheses, zinc ions promoters of bone remodelling by osteoblast
proliferation [11,13], and they contribute to extracellular matrix
calcification through the synthesis of matrix proteins in osteoblast
[12,13]. Zinc deficiency finally could be explain because patients
with renal failure can need supply for more time.
Conclusion
For the nutritional index, the BMI and MAC, oral administration
of 30mg / day of zinc sulphate resulted in an increased significant change in deposit mass compared with the group that received
only 15mg/day. The mass increase was significant on body mass
index and mid-arm circumference, in the age group under 14
who received 30mg/day of zinc sulphate. It was the same in our
patient; because she improve her BMI and W/H despite that, she
finished with hypozincemia.
The administration of zinc sulphate did not significantly
improve the final height or serum zinc. It is recommended seeing
the zinc as one of the essential micronutrient supplementation
in patients with chronic renal failure and for studies of zinc
deficiency in the development of other chronic diseases in which
malnutrition is present. However, a biomarker of changes in bone
zinc is not available at this time. Researchers are needed to better
understand links between bone zinc, diet zinc, and overall zinc
homeostasis [13].
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