Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome: a provisional study

Keenswijk, Werner; Ilias, Mohamad Ikram; Raes, Ann; Donckerwolcke, R. A.; Walle, Johan Vande

doi:10.1007/s00431-017-3029-2

Cited by 10 publications

(5 citation statements)

References 16 publications

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“…11 Hence, it did Keenswijk et al, who studied the K index as an indicator of hypovolemia in 44 children with nephrotic syndrome. 12 Iyenger et al, found that 50% of steroid responsive children and 36% of steroid non-responders had low K index suggestive of hypervolemia. 2 This may suggest that steroid resistance in nephrotic syndrome may favor hypovolemia.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive assessment of volume status of children with edema due to steroid sensitive nephrotic syndrome using urinary indices and inferior venacava ultrasonography

2023

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Background: It is clinically difficult to assess the intravascular volume status of children with edema in nephrotic syndrome. This makes decision-making challenging, regarding the use of diuretics or albumin infusion in the management of edema. Ideally, hormonal assay and central venous pressure monitoring are accurate but difficult to do as these methods are invasive and expensive to be applied to every child presenting with edema of nephrotic syndrome. Hence, the need for reliable non-invasive investigations to assess the volume status of children with edema. Aims and Objectives: The aim of the study was to assess the volume status of children with edema due to steroid sensitive nephrotic syndrome using noninvasive methods such as urinary indices (Fractional excretion of sodium (FeNa) and urine Potasium index (K index)) and inferior venacava diameter (IVCD) by ultrasonography and to determine the association between them. Materials and Methods: In this analytical cross-sectional study, 82 subjects fitting the inclusion criteria were included in the study. FeNa, K index and IVCD were determined. The volume status was assessed and association between the three calculated (Fischer exact test). Results: Out of 82 children, 56.1%, 68.3%, and 63.5% based on FeNa, K index, and IVCD respectively were having hypervolemic volume status. There is a statistically significant association between FeNa and K index and between urinary indices and IVCD. Conclusion: The present study supports the overfill hypothesis of edema formation. IVCD like urinary indices is a non-invasive and reliable investigation to determine volume status in nephrotic child with edema.

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Section: Discussionmentioning

confidence: 99%

Non-invasive assessment of volume status of children with edema due to steroid sensitive nephrotic syndrome using urinary indices and inferior venacava ultrasonography

2023

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“…The clinically impractical gold standard techniques of bromide or deuteriated water dilution have been supplanted in humans by indirect methods such as bioimpedance analysis and was therefore not performed in our pilot study [ 23 ]. Similarly, the urinary potassium/ (potassium + sodium) ratio has been suggested as a surrogate of hypovolemia in nephrotic children to replace the dilution methods with radioactively labeled red blood cells or proteins [ 24 ]. To date, the validity of this method has not been evaluated in companion animals.…”

Section: Discussionmentioning

confidence: 99%

The circulating renin-angiotensin-aldosterone system is down-regulated in dogs with glomerular diseases compared to other chronic kidney diseases with low-grade proteinuria

et al. 2022

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Glomerular diseases (GD) lead to a variety of disorders of the vascular and the total body water volumes. Various pathomechanisms, including vascular underfill and overfill, have been suggested to explain these disturbances. Accordingly, the circulating renin-angiotensin-aldosterone system (cRAAS) is expected to be activated as either a cause or a result of these fluid disorders. The aim of this study was to characterize the activity of the cRAAS in dogs with GD and to evaluate its relationship with the vascular volume status. In a prospective study, we evaluated the plasma renin activity and the serum aldosterone concentration in 15 dogs with GD. Their fluid volume status was estimated with clinical variables reflecting volemia and hydration, echocardiographic volume assessment, N-terminal pro B-type natriuretic peptide, blood urea nitrogen:creatinine ratio, and the urinary fractional excretion of sodium. Ten dogs with chronic kidney disease (CKD) with matching degree of azotemia were recruited as controls. The activity of the cRAAS was low in 10 dogs, normal in 3 dogs, high in 1 dog and equivocal (high renin—low aldosterone) in 1 dog with GD. These dogs had a lower cRAAS activity than dogs with CKD (p = 0.01). The clinical evaluation showed 8 hypovolemic and 7 non-hypovolemic dogs; 3 dehydrated, 9 euhydrated and 3 overhydrated dogs. The cRAAS activity was not different between hypovolemic and non-hypovolemic dogs. The down-regulated cRAAS without obvious association with the clinical volume status of these dogs with GD, suggests different mechanisms of fluid volume dysregulation in dogs with GD than previously assumed. This finding however should be confirmed in a focused larger scale study, as it may influence the use of cRAAS blockers as part of the standard therapy of GD in dogs.

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“…Typical values for pre-renal azotemia have not been precisely determined; in hypoperfusion, typical values are below 1 mmol/mmol [6]. The ratio of the urine potassium level to the sum of potassium and sodium is a recently described new parameter useful in testing for hypovolemia in nephrotic syndrome [21].…”

Section: Discussionmentioning

confidence: 99%

Biochemical Markers of Renal Hypoperfusion, Hemoconcentration, and Proteinuria after Extreme Physical Exercise

et al. 2019

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Background and Objectives: Physical exercise increases the blood perfusion of muscles, but decreases the renal blood flow. There are several markers of renal hypoperfusion which are used in the differential diagnosis of acute kidney failure. Albuminuria is observed after almost any exercise. The aim of this study was to assess changes in renal hypoperfusion and albuminuria after a 100-km race. Materials and Methods: A total of 27 males who finished a 100-km run were studied. The mean age of the runners was 38.04 ± 5.64 years. The exclusion criteria were a history of kidney disease, glomerular filtration rate (GFR) <60 ml/min, and proteinuria. Blood and urine were collected before and after the race. The urinary albumin/creatinine ratio (ACR), fractional excretion of urea (FeUrea) and sodium (FeNa), plasma urea/creatinine ratio (sUrea/Cr), urine/plasma creatinine ratio (u/pCr), urinary sodium to potassium ratio (uNa/K), and urinary potassium to urinary potassium plus sodium ratio (uK/(K+Na)) were calculated. Results: After the race, significant changes in albuminuria and markers of renal hypoperfusion (FeNa, FeUrea, sUrea/Cr, u/sCr, urinary Na, uNa/K, uK/(K+Na)) were found. Fifteen runners (55.56%) had severe renal hypoperfusion (FeUrea <35, uNa/K <1, and uK/(Na+K) >0.5) after the race. The mean ACR increased from 6.28 ± 3.84 mg/g to 48.43 ± 51.64 mg/g (p < 0.001). The ACR was higher in the group with severe renal hypoperfusion (59.42 ± 59.86 vs. 34.68 ± 37.04 mg/g), but without statistical significance. Conclusions: More than 50% of the runners had severe renal hypoperfusion after extreme exercise. Changes in renal hemodynamics are probably an important, but not the only, factor of post-exercise proteinuria.

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Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome: a provisional study

Cited by 10 publications

References 16 publications

Non-invasive assessment of volume status of children with edema due to steroid sensitive nephrotic syndrome using urinary indices and inferior venacava ultrasonography

Non-invasive assessment of volume status of children with edema due to steroid sensitive nephrotic syndrome using urinary indices and inferior venacava ultrasonography

The circulating renin-angiotensin-aldosterone system is down-regulated in dogs with glomerular diseases compared to other chronic kidney diseases with low-grade proteinuria

Biochemical Markers of Renal Hypoperfusion, Hemoconcentration, and Proteinuria after Extreme Physical Exercise

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