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

• Published in: European journal of pediatrics Vol. 177; no. 1; pp. 79 - 84
• Main Authors: Keenswijk, Werner, Ilias, Mohamad Ikram, Raes, Ann, Donckerwolcke, Raymond, Walle, Johan Vande
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2018; Springer Nature B.V
• Subjects: Adolescent; Albumin; Biomarkers - urine; Case-Control Studies; Child; Child, Preschool; Children; Edema; Female; Glomerular Filtration Rate; Humans; Hypovolemia - diagnosis; Hypovolemia - etiology; Hypovolemia - urine; Infant; Inulin; Kidney diseases; Kidneys; Male; Medicine; Medicine & Public Health; Nephrotic syndrome; Nephrotic Syndrome - complications; Original Article; Pediatrics; Perfusion; Permeability; Potassium; Potassium - urine; Prospective Studies; Renin; Sodium; Sodium - urine; Nephrotic syndrome; Aldosterone; Hypovolemia; Plasma renin activity; Acute kidney injury; Urinary potassium to urinary potassium plus sodium ratio
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-017-3029-2

There is evidence pointing to a decrease of the glomerular filtration rate (GFR) in a subgroup of nephrotic children, likely secondary to hypovolemia. The aim of this study is to validate the use of urinary potassium to the sum of potassium plus sodium ratio (UK/UK+UNa) as an indicator of hypovolemia in nephrotic syndrome, enabling detection of those patients who will benefit from albumin infusion. We prospectively studied 44 nephrotic children and compared different parameters to a control group (36 children). Renal perfusion and glomerular permeability were assessed by measuring clearance of para-aminohippurate and inulin. Vaso-active hormones and urinary sodium and potassium were also measured. Subjects were grouped into low, normal, and high GFR groups. In the low GFR group, significantly lower renal plasma flow ( p  = 0.01), filtration fraction ( p  = 0.01), and higher UK/UK+UNa ( p  = 0.03) ratio were noted. In addition, non-significant higher plasma renin activity ( p  = 0.11) and aldosteron ( p  = 0.09) were also seen in the low GFR group. Conclusion : A subgroup of patients in nephrotic syndrome has a decrease in glomerular filtration, apparently related to hypovolemia which likely can be detected by a urinary potassium to potassium plus sodium ratio > 0.5–0.6 suggesting benefit of albumin infusion in this subgroup. What is Known: • Volume status can be difficult to assess based on clinical parameters in nephrotic syndrome, and albumin infusion can be associated with development of pulmonary edema and fluid overload in these patients. What is New: • Urinary potassium to the sum of urinary potassium plus sodium ratio can accurately detect hypovolemia in nephrotic syndrome and thus identify those children who would probably respond to albumin infusion.