Ratio of Urinary Potassium to Urinary Sodium and the Potassium and Edema Status in Nephrotic Syndrome

Matsumoto, Hiroshi; Miyaoka, Yoshitaka; Okada, Tomonari; Nagaoka, Yume; Wada, Toshikazu; Gondo, Asako; Esaki, Shinga; Hayashi, Aeru; Nakao, Toshiyuki

doi:10.2169/internalmedicine.50.4537

Cited by 11 publications

(7 citation statements)

References 13 publications

(19 reference statements)

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“…FENa alone cannot be used to differentiate between primary and secondary sodium retention. However, in children with NS, strong positive correlations were found between U K /U Na+K ratio and plasma aldosterone (19). It can be useful in differentiating primary sodium retention from secondary sodium retention in NS patients (18).…”

Section: Discussionmentioning

confidence: 99%

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

Büyükavcı¹,

Çivilibal²,

Elevli³

et al. 2015

Turk J Med Sci

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Background/aim: The mechanism of edema formation in nephrotic syndrome is still poorly understood. We aimed to evaluate the volume status in children with steroid-sensitive nephrotic syndrome (SSNS) and to emphasize the importance of echocardiography in demonstrating of volume changes.Materials and methods: Thirty-two SSNS patients and 30 healthy children were enrolled in this study. The volume statuses of patients were evaluated by clinical and laboratory features, including fractional sodium excretion (FENa) and distal sodium/potassium exchange (UK/UNa+K ratio). Inferior vena cava collapsibility index (IVCCI), left atrial diameter (LAD), aortic diameter (AD), and left ventricular mass index (LVMI) were measured using conventional echocardiographic methods.Results: FENa was lower in children with NS; however, the distal K/Na ratio of the patient and control groups did not differ. In addition, IVCCI, LAD, AD, and LVMI were not different among groups. When evaluating the volume status of patients, 8 patients (25%) were hypovolemic while 24 patients (75%) were nonhypovolemic (normovolemic or hypervolemic). LAD was significantly lower in hypovolemic patients. Conclusion:The majority of children with SSNS are normovolemic or hypervolemic and echocardiography is an easy and valuable method for the evaluation of volume status in these patients.

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Section: Discussionmentioning

confidence: 99%

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

Büyükavcı¹,

Çivilibal²,

Elevli³

et al. 2015

Turk J Med Sci

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“…Patients with NS and hypovolemia typically show low FENa+ (often below 0.2%) and a high urinary K + /K + +Na + index (greater than 60%) (8,(39)(40)(41)(42)(43). Management of edema in such patients demands correction of the intravascular volume with infusion of albumin ore non-protein colloids before initiation of diuretic therapy.…”

Section: How Can the Volume Status Be Assessed In Patients With Nephrmentioning

confidence: 99%

“…Patients with edema and clinical and/or laboratory features of hypervolemia (FENa+>1% and urinary K + /K + +Na + index <60%) can safely be treated with diuretics (8,(39)(40)(41)(42)(43). Intravascular infusion of albumin and colloids in such patients put them at risk of volume overload and lung edema.…”

Section: How Can the Volume Status Be Assessed In Patients With Nephrmentioning

confidence: 99%

Edema in Renal Diseases – Current View on Pathogenesis

Bobkova

Chebotareva

Kozlovskaya

et al. 2016

Nephrology @ Point of Care

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QUESTIONS @ POINT OF CARE markable. One month before admission minimal proteinuria was found. Physical examination did not reveal any significant signs and symptoms beyond edema. Urinalysis demonstrated nephrotic range proteinuria (10 g/day) without any abnormalities of the urinary sediment. Total blood count showed hemoglobin 12.5 g/dL, an erythrocyte sedimentation rate of 40 mm/h, hematocrit 54%. The main biochemical data are summarized in Table I. No monoclonal component was found either in the serum or the urine. Thromboembolic events were not observed. Ultrasonography revealed two normal-sized kidneys and presence of ascites. Chest plain radiography revealed bilateral hydrothorax. Limitation of the oral sodium intake to 2.5 g daily was recommended. The intravascular volume was corrected by intravenous infusions of 20% albumin (2 mL/min for 1-1.5 hours). Intravenous infusions of furosemide (initial bolus-60 mg, followed by continuous infusions-60 mg/h) were

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“…Donckerwolcke et al28) found a better correlation between log aldosterone and urinary potassium / urinary potassium + urinary sodium (U K / U Na + U K ) ratio than with other parameters measuring renal potassium and sodium handling. In patients with renal sodium retention (FENa: <0.5%), U K / U Na + U K ratio of higher than 0.6 (U K / U Na + U K : >60%) identifies patients with increased aldosterone levels and functional hypovolemia29).…”

Section: Nephrotic Syndrome-related Complicationsmentioning

confidence: 99%

“…This index may therefore be used to assess which patients will benefit from intravenous normal saline (20 mL/kg over 1 to 2 hours) or albumin administration at maximum dose of 1 g/kg over 3 to 5 hours with blood pressure monitoring29). The administration of albumin is not routinely given to all patients in relapse and may be dangerous in children who are not volume depleted due to the risk of pulmonary edema.…”

Section: Nephrotic Syndrome-related Complicationsmentioning

confidence: 99%

Complications of nephrotic syndrome

2011

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Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS.

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Ratio of Urinary Potassium to Urinary Sodium and the Potassium and Edema Status in Nephrotic Syndrome

Cited by 11 publications

References 13 publications

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

Hypo- and hypervolemic edema in children with steroidsensitive nephrotic syndrome

Edema in Renal Diseases – Current View on Pathogenesis

Complications of nephrotic syndrome

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