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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.
Keywords
Nephrotic syndrome, Hypovolemia, Acute kidney injury, Urinary potassium to urinary potassium plus sodium ratio, Aldosterone, Plasma renin activity, ACUTE-RENAL-FAILURE, CHILDREN, EDEMA, PATHOPHYSIOLOGY, MANAGEMENT

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MLA
Keenswijk, Werner et al. “Urinary Potassium to Urinary Potassium Plus Sodium Ratio Can Accurately Identify Hypovolemia in Nephrotic Syndrome : a Provisional Study.” EUROPEAN JOURNAL OF PEDIATRICS 177.1 (2018): 79–84. Print.
APA
Keenswijk, W., Ilias, M. I., Raes, A., Donckerwolcke, R., & Vande Walle, J. (2018). Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome : a provisional study. EUROPEAN JOURNAL OF PEDIATRICS, 177(1), 79–84.
Chicago author-date
Keenswijk, Werner, Mohamad Ikram Ilias, Ann Raes, Raymond Donckerwolcke, and Johan Vande Walle. 2018. “Urinary Potassium to Urinary Potassium Plus Sodium Ratio Can Accurately Identify Hypovolemia in Nephrotic Syndrome : a Provisional Study.” European Journal of Pediatrics 177 (1): 79–84.
Chicago author-date (all authors)
Keenswijk, Werner, Mohamad Ikram Ilias, Ann Raes, Raymond Donckerwolcke, and Johan Vande Walle. 2018. “Urinary Potassium to Urinary Potassium Plus Sodium Ratio Can Accurately Identify Hypovolemia in Nephrotic Syndrome : a Provisional Study.” European Journal of Pediatrics 177 (1): 79–84.
Vancouver
1.
Keenswijk W, Ilias MI, Raes A, Donckerwolcke R, Vande Walle J. Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome : a provisional study. EUROPEAN JOURNAL OF PEDIATRICS. 2018;177(1):79–84.
IEEE
[1]
W. Keenswijk, M. I. Ilias, A. Raes, R. Donckerwolcke, and J. Vande Walle, “Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome : a provisional study,” EUROPEAN JOURNAL OF PEDIATRICS, vol. 177, no. 1, pp. 79–84, 2018.
@article{8539129,
  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.},
  author       = {Keenswijk, Werner and Ilias, Mohamad Ikram and Raes, Ann and Donckerwolcke, Raymond and Vande Walle, Johan},
  issn         = {0340-6199},
  journal      = {EUROPEAN JOURNAL OF PEDIATRICS},
  keywords     = {Nephrotic syndrome,Hypovolemia,Acute kidney injury,Urinary potassium to urinary potassium plus sodium ratio,Aldosterone,Plasma renin activity,ACUTE-RENAL-FAILURE,CHILDREN,EDEMA,PATHOPHYSIOLOGY,MANAGEMENT},
  language     = {eng},
  number       = {1},
  pages        = {79--84},
  title        = {Urinary potassium to urinary potassium plus sodium ratio can accurately identify hypovolemia in nephrotic syndrome : a provisional study},
  url          = {http://dx.doi.org/10.1007/s00431-017-3029-2},
  volume       = {177},
  year         = {2018},
}

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