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

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Abstract

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.

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Abbreviations

Cr:

Creatinine

FE Na:

Fractional sodium excretion

FF:

Filtration fraction

GFR:

Glomerular filtration rate

IARF:

Idiopathic renal failure

NS:

Nephrotic syndrome

PAH:

Para-aminohippurate

PRA:

Plasma renin activity

RPF:

Renal plasma flow

UK:

Urinary potassium

UNa:

Urinary sodium

U pr/Cr ratio:

Urinary protein/creatinine ratio

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Authors and Affiliations

  1. Department of Paediatrics, Paediatric Nephrology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium

    Werner Keenswijk, Mohamad Ikram Ilias, Ann Raes, Raymond Donckerwolcke & Johan Vande Walle

Authors
  1. Werner Keenswijk
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  2. Mohamad Ikram Ilias
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  3. Ann Raes
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  4. Raymond Donckerwolcke
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  5. Johan Vande Walle
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Contributions

Werner Keenswijk and Mohamad Ikram Ilias wrote the initial draft of this manuscript. All authors contributed to drafting, revising, and finalizing the manuscript and agreed with submission to the European journal of pediatrics.

Corresponding author

Correspondence to Werner Keenswijk.

Ethics declarations

The study was performed in accordance with the Declaration of Helsinki and ethical approval was obtained from the hospital ethical committee.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Communicated by Mario Bianchetti

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Keenswijk, W., Ilias, M.I., Raes, A. et al. Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome: a provisional study. Eur J Pediatr 177, 79–84 (2018). https://doi.org/10.1007/s00431-017-3029-2

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  • DOI: https://doi.org/10.1007/s00431-017-3029-2

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