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Urinary retinol excretion in children with acute watery diarrhoea
Amal K Mitra1, Mohammad A Wahed, Ashish K Chowdhury
1University of Southern Mississippi, Center for Community Health, Hattiesburg 39406-5122, USA. amal.mitra@usm.edu
Insights
Children with diarrhea excrete significant amounts of retinol in urine, potentially depleting liver reserves. Kidney dysfunction and increased retinol-binding protein (RBP) excretion contribute to this loss.
Area of Science:
- Pediatrics
- Nutritional Science
- Gastroenterology
Background:
- Rotavirus infection in children causes urinary retinol excretion.
- The mechanism and extent of urinary retinol loss in non-rotavirus diarrhea remain unclear.
Purpose of the Study:
- To determine the extent and mechanism of urinary retinol excretion in children with acute watery diarrhea caused by pathogens other than rotavirus.
- To investigate the relationship between serum retinol, retinol-binding protein (RBP), and kidney tubular function in these children.
Main Methods:
- Studied 32 children (5 months to 5 years) hospitalized with watery diarrhea due to enterotoxigenic Escherichia coli in Bangladesh.
- Measured serum retinol and RBP levels at admission and post-recovery.
- Assessed urinary retinol excretion and kidney tubular dysfunction, including RBP excretion.
Main Results:
- Serum retinol and RBP were low on admission and increased significantly after recovery.
- 47% of children excreted retinol in urine on day 1, and 38% on day 3.
- Urinary retinol loss represented over 40% of liver retinol reserves in malnourished children.
- Increased RBP excretion significantly predicted urinary retinol excretion.
Conclusions:
- Children with watery diarrhea due to pathogens like enterotoxigenic E. coli can excrete significant amounts of retinol in urine.
- This urinary retinol loss can deplete liver retinol reserves, particularly in malnourished children.
- Kidney tubular dysfunction, indicated by increased RBP excretion, is a key factor in urinary retinol loss during acute watery diarrhea.
Abstract:
Children with diarrhoea due to rotavirus infection excrete retinol in urine. This study aimed at demonstrating the extent and mechanism of urinary retinol excretion in children with acute watery diarrhoea caused by pathogens other than rotavirus. Thirty-two children, aged five months to five years, hospitalized with watery diarrhoea predominantly due to enterotoxigenic Escherichia coli in Bangladesh, were studied. Their serum retinol and retinol-binding protein (RBP) were low at admission and increased significantly after recovery from illness. The mean hospital stay of these patients was four days. Forty-seven percent of the children excreted retinol in urine on day 1, and about 38% continued excreting retinol on day 3. The estimated urinary retinol loss of 3.44 micromol for the illness episode represented more than 40% of liver retinol reserve (8.25 micromol) in malnourished children. A conservative estimate of the loss would represent at least 20% of the liver reserve in relatively better-nourished children. Kidney tubular dysfunctions of increased RBP excretion significantly predicted urinary retinol excretion in children with watery diarrhoea.