Role of aldosterone in the sodium retention of patients with nephrotic syndrome

Am J Nephrol. 1990;10(1):44-8. doi: 10.1159/000168052.

Abstract

The role of aldosterone in the abnormal sodium retention in patients with nephrotic syndrome has been debated. In fact, studies using a converting enzyme inhibitor to lower plasma aldosterone have rejected such a role. We therefore studied 5 nephrotic patients and 6 control subjects by using the more specific aldosterone antagonist, spironolactone. After withdrawal of diuretics 5 days prior to the study, the nephrotic patients and control subjects were placed on a high-sodium diet (285 +/- 6 mEq/day) for 8 days. After 4 days, spironolactone 200 mg p.o., b.i.d., was given for the remaining 4 days. Plasma renin activity and plasma aldosterone levels were similar in both nephrotic patients and control subjects before the study, after sodium loading and after spironolactone had been given. After 4 days of high sodium intake control subjects were in sodium balance, but the nephrotic patients were in a positive sodium balance (approx. 80 mEq/day; p less than 0.01). On days 3 and 4 of spironolactone, the nephrotic patients exhibited an increase in urinary sodium excretion (205 +/- 20 vs. 312 +/- 13 mEq/day; p less than 0.005) but not the control subjects (279 +/- 16 vs. 286 +/- 13 mEq/day; NS). It is therefore concluded that aldosterone is a significant contributor to the sodium retention in patients with nephrotic syndrome.

MeSH terms

  • Adult
  • Aldosterone / blood
  • Aldosterone / physiology*
  • Blood Pressure
  • Glomerular Filtration Rate
  • Humans
  • Male
  • Middle Aged
  • Nephrotic Syndrome / blood
  • Nephrotic Syndrome / metabolism*
  • Nephrotic Syndrome / urine
  • Potassium / administration & dosage
  • Potassium / blood
  • Renin / blood
  • Sodium / blood
  • Sodium / metabolism*
  • Sodium / urine
  • Sodium, Dietary / administration & dosage
  • Spironolactone / pharmacology*

Substances

  • Sodium, Dietary
  • Spironolactone
  • Aldosterone
  • Sodium
  • Renin
  • Potassium