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Chromosome 19 19q13.1
Congenital Nephrotic Syndrome

I am not a medical doctor, this is not medical advice.
I was mother to a child with CNS.

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While there are many different conditions that can be caused by any chromosomal disorder, including many different conditions that chromosome 19 can cause, I will be concentrating mainly on Congenital Nephrotic Syndrome. I have added other chromosome 19 information towards the bottom as I find it since you followed your search here.

Congenital Nephrotic Syndrome (CNS) is different than acquired nephrotic syndrome. It (CNS) can't be cured at this point in time. Congenital means "to be born with". Acquired nephrotic syndrome might be cured with steroids and/or other drug therapies.

CNS is a genetic mutation of the 19th chromosome. The mutation can be caused by many different factors such as:

  • Inherited:

    Autosomal recessive trait. The Finnish have the highest ratio of CNS births as 1/8000 births. But all nationalities are susceptible.

    Congenital Nephrotic Syndrome of the Finnish type (CNF) maps to the long arm of chromosome 19 in the immediate vicinity of the markers D19S224 and D19S220.

  • TORCH virii activated during pregnancy:
    • Toxoplasmosis virus
    • Other virii not yet discovered
    • Rubella
    • Cytomegalovirus (CMV)
    • Herpes Simplex virus
  • Random mutations from many reasons:
    • Too much heat to the developing fetus
    • Exposure to environmental toxins
    • Exposure to radiation (during fetal development)
    • Exposure to chemotherapy (during fetal development)
    • Many other reasons...

What does CNS do to a baby? The kidney has smaller things inside of it called nephrons, these are the actual workhorses of the kidney's trash filtering functions. Inside of the nephrons are glomeruli, and the basement membrane of these glomeruli's have little holes in them, compare them to a filter.

To put it in much simpler and understandable language, the little holes are too big in all CNS babies and persons with acquired nephrotic syndrome. In persons with normal sized glomeruli filters, the body's proteins are too big to fit through them and just the smaller trash of the body can fit through the small holes of the filters. But, for babies with CNS and other persons with acquired nephrotic syndrome, the filter holes are big enough to allow their body's proteins to escape through the filter holes. This is not good and that's an understatement.

Why are these proteins that escape through the filters so important, and what can happen because of the protein losses?

  • Anti-clotting factor proteins (Anti Thrombin III)
  • The anti-clotting factor proteins escape through the filters and this causes the body to have too little anti-clotting abilities. This means that blood clots can easily form anywhere where there is blood. These clots can cause blockages where blood can no longer get past the clots and whatever is on the other side of the clot is starved for oxygen that is carried by the blood. Not good!

  • Albumin proteins
  • Albumin is one of the components of blood. It helps to keep the correct ratio of water in the blood. Think of them as little sponges that absorb water from the tissues outside of the blood vessels into the actual blood vessels (through the water permeable membranes of the blood vessels). If one has the correct amouts of albumin in their blood, then they will stay balanced in how much water is in the blood. But, if one does not have enough albumin in their blood, then their blood can become too thick from being dehydrated. Think about this for a second, if the blood is already too thick, and add the fact that there aren't enough anti-clotting factors, this makes it doubly worse for clot formation.

    Where does the water from the blood go? It goes into the tissues outside of the blood vessels. This causes one to become puffy looking from the swelling caused by too much water in the tissues. The water also can go to the lungs (as well as many other organs). Swollen lung tissues are not good, it cuts down on the amount of oxygen that is exchanged in the alveoli's of the lungs. This means one does not get enough oxygen in their blood. Not good!

  • Immune system proteins
  • You may have heard of gamma globulins, they are lost through the filters of the kidney's glomeruli memebranes. This means that there is basically no immune system. One will not be able to fight off even the most minor bacteria, virus or fungi that may invade the body. Not good!

  • Thyroid binding factor proteins
  • Thryroid binding factors are protein enzymes that help the thryroid to make it's important hormones. Not having enough of these will affect the hormones that the thyroid produces and hypothyroidism will occur. Not good!

  • Nutrition and metabolic proteins
  • Without nutritional proteins, one will not grow well. If one's body is unable to get the required proteins to grow, then it stands to reason that it does not get enough to sustain living after a certain amout of time. Anyone that is in a state of starvation, no matter the cause, will have to utilize their own proteins, including the heart muscle.

    Also, when the body does have to use it's own proteins in order to recieve the required nutrition, it has to chemically convert the protein to into a carbohydrate so that the brain can be fed. The leftovers from the chemical reactions will cause the acid levels of the blood to become too high and throw off one's acid/base balance. Not good!.

    Also, the immune system uses proteins to make antibodies. The immune system is already depleted from the loss of the gamma globulins, so this makes it even worse. Not good!


  • Alpha fetal proteins (AFP) can be measured while the mother is still carrying the child by either performing chorionic villi sampling (CVS) and/or amnioscentesis. The AFP levels will be extremely high.

    NOTE - AFP's are measured in many other diagnostic tests and having high levels of AFP's does not mean that CNS will occur. Also note that advanced maternal age can cause higher AFP levels without any actual reason other than the mother's age.

  • The placenta is usually less than 20% in weight of the delived baby, however in most cases involving CNS, the placenta is more than 25% in weigh of the delivered CNS baby. The reason for this is due to the protein losses through the filters of the glomeruli. The proteins are excreted via the urine of the fetus, and the proteins nourish the placenta, causing it to grow extremely large.

  • Serum (blood) electrophoresis compared to urine electrophoresis are tests to measure the amounts of proteins in the blood and the urine. Both the blood and the urine are supposed to have a certain ratio to one another. When the ratio's are higher in the urine and lower in the blood than what is considered normal, this indicates possible CNS. The electrophoresis can also distinguish which proteins are which, helping to narrow the diagnosis.

  • Another blood test for albumin levels will show lower levels of albumin in the blood.

  • Edema (swelling) and generalized puffiness caused by the albumin losses as mentioned earlier.

  • PT/PTT/INR are blood tests to measure the blood's ability to clot. Higher numbers mean higher chances of clotting.

Treatment of CNS

  • Primary treatment of CNS
    • Heparin (a blood thinner) may be given intra-venously to prevent blood clotting.

    • Albumin may be given intra-venously to help balance the intra-vessicular hydration status.

      NOTE - heparin and albumin maybe be placed into the same IV bag to prevent the need for numerous peripheral IV sites. Please have your doctors contact the pediatric nephrology team at University of Houston Medical Center in Houston to verify this. They spent a considerable amout of time researching this, and had the documentation sent to them while my son was their patient from 1997-1998.

    • Immuno globulins, mainly Ig G, may be infused should an infection be suspected. Also, antibiotic therapy should be started if more than a few fevers have developed. Blood tests such as CBC (complete blood count) may be performed to detect increased white blood counts (WBC). These are all very important, as infections can be lethal when one has a very limited immune system to fight off infections.

    • A thyroid medication (Synthroid for example) may be given to prevent hypothyroidism.

    • A specialized renal (kidney) diet, that is supplemented with more proteins than is normally required by persons not suffering from nephrotic syndrome, will help to nourish the body.

  • Dialysis
    • The more commonly known hemodialysis is considered to be too harsh for babies. Peritoneal dialysis is preferred as it does not cause the rapid and harsh fluid and electrolyte shifting. A tube is placed into the abdominal region. It is called peritoneal dialysis tube (PDT).

      The end of the tube goes into the peritoneum, which is the cavity that houses the digestive organs such as the stomach and the intestines. The peritoneal dialysis fluid is called dialysate. When the dialysate enters the peritoneum via the PDT, it is actually the peritoneal lining that perfoms the dialysis.

      There will be numerous cycles of the dialysis, with fresh dialysate going in and staying in the peritoneum for a prescribed amount of time and then the dialysate will be allowed to drain out, taking the wastes of the body along with it. Then the process is repeated for the prescribed amounts of times.

      Peritoneal dialysis can be performed while the kidney's are still in the body. This is not ideal for a long period of time, as the kidney's will still allow protiens to escape through the glomeruli filters. So, after the PDT and surrounding tissues have healed and dialysis has been proven to work by seeing if the PDT is patent and how much the peritoneum can hold, the kidneys will usually be removed. This will now change the diagnosis of having CNS to being a dialysis patient.

      My William's kidneys were removed. The name of this surgery is bilateral nephrectomy. Many have asked why just one kidney could not have remained. The answer is because the proteins would continue to escape, as both sides were affected with CNS. It is probable that with acquired nephrotic syndome, if only one kidney were affected, then just that affected kidney could be removed and dialysis and transplant might not be necessary.

      After Williams kidneys were removed and he was still on pain medications, the dialysis team came to perform the first dialysis. Most of the team were specialized in pediatric dialysis (this was a state of the art hospital in Houston). I can't help but smile at the memory of one of the nurses that kept covering him with the diaper so that he would not have an accident on them. I mentioned that the doctors specifically stated that the inguinal hernia repair sites were to be watched during the first real dialysis to make sure that they held and with him covered with his diaper, they would not be able to monitor this and there was no reason to worry about him having an accident, as he no longer had his kidneys. She looked rather sheepish *hee hee*

      The number of times the cycles must be repeated are determined by how much dialysate the peritoneum can hold, and most first time dialysis attempts must not be able to hold much, especially with babies. So he had to have numerous cycles and was hooked up most of the day at first. They put in a bit more each time and over time, he was only hooked up about 8 hrs a night. With the smaller amount of time, and the promise that he would have care by parent 24 hours a day, he was transferred to his private room, I was thrilled for this way I would be able to actually sleep there at the hospital and spend more time with him. After settling into the new unit for about a week (for the new nurses to get used to his higher than normal acuity level), our dialysis by parent training was started.

      To train parents in peritoneal dialysis usually takes a week or so, but they had never trained parents that were both nurses. Our training was completed in about 1 1/2 days and the remainder of the time was spent observing to make sure that we had it down as perfectly as possible and also trouble-shooting and how to respond to problems.

      As ideal as peritoneal diaysis is when compared to hemodialysis, the peritoneal version is usually short lived. If peritonitis (infection of the peritoneal cavity) occurs bad enough to cause even the slightest damage to the peritoneal lining, then the patient will have to be converted over to hemodialysis. Hopefully, the patient will be old enough not to be affected in adverse ways by hemodialysis. My friend's son was the youngest that we know of to do well on hemodialysis and I am going to get her to write an article for this page about that, and about her son's transplant of her kidney to him, since I was unable to give my kidney to my son and can't write as much due to lack of experience in this subject.

      Back to peritonitis, since the body's been invaded by an unnatural PDT, this raises the chances of infection starting up in the surrounding skin and tissues of the tube, the inside of the tube itself can carry the infection into the peritoneum. The training covered aseptic technique (which was more sterile than any sterile procedure I have ever seen or done!). Without going into great detail, I will try to cover the basics of the aseptic techniques that were used.

      • Sterile gloves were not used, if nothing comes in actual contact with any of the actual dialysis equipment and dialysate and tubing, then it is fine not to use sterile gloves. Masks were required though. They had cultured many of the patients in the past that had come down with peritonitis and found in many cases that the bacteria was airborn, hence the use of masks.

        All windows and air vents in the ceilings and walls also had to be covered to make sure that there was not a draft during the setup. Doors were not allowed to be opened during setup either. This was difficult to enforce even with big caution signs placed on the door at the hospital. We ended up placing a heavy chair up against the door and when personel would try to enter, they couldn't open the door very well with the chair placed up against it and this would give us the chance to yell through the door to please read the sign and no one was allowed in until set up was completed.

      • Alcohol was used to initially disinfect the covers of drugs that were to be placed into the dialysate and the sites where the drugs were injected. Then, after the initial cleansing with alcohol, the very same sites had to have betadine swabs placed over them and let them stay on them for the predermined time (I don't recall the time, but it seemed like forever). After the betadine had set long enough, then the drugs could be pulled and injected into the dialysate. Then the dialysate could be punctured by the dialysis tubing (much like IV tubing, only larger). After the tubing had been primed (this means to get the dialysate in all the area's of the tubing with as little air bubbles as possible), the next step could occur.

      • The next step was to prepare the site on the abdomen, where the PDT was in place. After the dressing had been removed, then the skin surrounding the PDT had to be cleansed with betadine and then the betadine had to be removed with alcohol. The cleansing is very similiar to subclavian IV site dressing changes and cleansing if any of you have ever witnessed this. One starts up against the tube and then make circles increasing in size towards the outer parts while changing out the betadine swab as one gets more towards the outer areas. This prevents the germs of the skin from the outer parts from creeping in to the tube area. This is repeated with the alcohol. After everything had dried, then the new dressing could be placed.

        If the baby or child is asleep during this, it makes it much easier, as the child will not try to touch the area's that need to be kept aseptic. If the child does touch the aseptic area's of their abdomen, or any of the tubing, then the contaminated parts have to be cleansed again, starting from scratch of whatever was contaminated

      • Now the primed dialysate tubing can be connected to the PDT, after proper cleansing of the end of the PDT. This involves placing a little cover cap that has betadine inside of it over the end of the PTD for the required amount of time. We would place the betadine caps over the end of the PDT during the dressing change to save time. If everything has been done correctly without any touching of anything except for with the betadine, then the tubing can be attached to the PDT.

      • Now the gloves and masks can be revoved, the doors can be opened, and the coverings to the vents can be removed. We all were pretty hot by this time and usually took a moment to cool ourselves off and get a drink before programming the peritoneal dialysis machine. But aseptic time was over, until the next day.

  • Transplant
    • I hope to get my friend to help out with this part, as she's very experienced with transplantation. She donated her kidney to her son that had CNS. She's very busy a lot of times, so it might be a while before this is updated. Meanwhile, you may check out my Donation and Transplant page if you wish to, it has a few links (since I edited it while sleepy, I have to rebuild my links), but there is a webring on it for you to be able to stick strictly with the transplantation subject if that is what you are looking for.

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