Association of Plasminuria with Overhydration in Patients with CKD

Schork A, Woern M, Kalbacher H, Voelter W, Nacken R, Bertog M, Härteis S, Korbmacher C, Heyne N, Peter A, Haering HU, Artunc F (2016)

Publication Type: Journal article

Publication year: 2016

Journal

Book Volume: 11

Pages Range: 761-9

Journal Issue: 5

DOI: 10.2215/CJN.12261115

Abstract

Hypervolemia is a common feature of patients with CKD and associated with hypertension. Recent work has shown stimulation of sodium retention by urinary plasmin during nephrotic syndrome. However, it is unclear whether plasminuria plays a role in patients with stable CKD and non-nephrotic proteinuria.In this cross-sectional study, we analyzed the fluid status of 171 patients with CKD consecutively presenting to our outpatient clinic from 2012 to 2013 using bioimpedance spectroscopy (Body Composition Monitor [BCM]; Fresenius Medical Care, Germany) and its associations to the urinary excretion of plasminogen and plasmin from a spot urine sample. Two-electrode voltage clamp measurements were performed in Xenopus laevis oocytes expressing human epithelial sodium channel to investigate whether plasmin in concentrations found in urine can activate the channel.Overhydration >5% and overhydration >10% of the extracellular volume were found in 29% and 17% of the patients, respectively, and overhydration was associated with edema, hypertension, higher stages of CKD, and proteinuria. Proteinuria was the strongest independent predictor for overhydration (+0.58 L/1.73 m(2) per 10-fold increase; P<0.001). Urinary excretion of plasmin(ogen) quantified by ELISA correlated strongly with proteinuria (r=0.87) and overhydration (r=0.47). Using a chromogenic substrate, active plasmin was found in 44% of patients and correlated with proteinuria and overhydration. Estimated urinary plasmin concentrations were in a range sufficient to activate epithelial sodium channel currents in vitro. In multivariable analysis, urinary excretion of plasmin(ogen) was associated with overhydration similar to proteinuria.Hypervolemia in patients with CKD is strongly associated with proteinuria, even in the non-nephrotic range. Protein-rich urine contains high amounts of plasminogen and active plasmin, rendering plasminuria as a possible link between proteinuria and hypervolemia.

Authors with CRIS profile

Involved external institutions

Universitätsklinikum Tübingen Germany (DE) Eberhard Karls Universität Tübingen Germany (DE)

How to cite

APA:

Schork, A., Woern, M., Kalbacher, H., Voelter, W., Nacken, R., Bertog, M.,... Artunc, F. (2016). Association of Plasminuria with Overhydration in Patients with CKD. Clinical Journal of the American Society of Nephrology, 11(5), 761-9. https://doi.org/10.2215/CJN.12261115

MLA:

Schork, Anja, et al. "Association of Plasminuria with Overhydration in Patients with CKD." Clinical Journal of the American Society of Nephrology 11.5 (2016): 761-9.

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