Correlation between kidney sodium and potassium handling and the renin-angiotensin-aldosterone system in children with hypertensive disorders,Pediatric Nephrology

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Correlation between kidney sodium and potassium handling and the renin-angiotensin-aldosterone system in children with hypertensive disorders
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2021-09-09 , DOI: 10.1007/s00467-021-05204-7
Ella C Perrin ₁ , Andrew M South _{2,

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Affiliation

Background

Urine sodium and potassium are used as surrogate markers for dietary consumption in adults with hypertension, but their role in youth with hypertension and their association with components of the renin-angiotensin-aldosterone system (RAAS) are incompletely characterized. Some individuals with hypertension may have an abnormal RAAS response to dietary sodium and potassium intake, though this is incompletely described. Our objective was to investigate if plasma renin activity and serum aldosterone are associated with urine sodium and potassium in youth referred for hypertensive disorders.

Methods

This pilot study was a cross-sectional analysis of baseline data from 44 youth evaluated for hypertensive disorders in a Hypertension Clinic. We recorded urine sodium and potassium concentrations normalized to urine creatinine, plasma renin activity, and serum aldosterone and calculated the sodium/potassium (UNaK) and aldosterone/renin ratios. We used multivariable generalized linear models to estimate the associations of renin and aldosterone with urine sodium and potassium.

Results

Our cohort was diverse (37% non-Hispanic Black, 14% Hispanic), 66% were male, and median age was 15.3 years; 77% had obesity and 9% had a secondary etiology. Aldosterone was associated inversely with urine sodium/creatinine (β: −0.34, 95% CI −0.62 to −0.06) and UNaK (β: −0.09, 95% CI −0.16 to −0.03), and adjusted for estimated glomerular filtration rate and serum potassium.

Conclusions

Higher serum aldosterone levels, but not plasma renin activity, were associated with lower urine sodium/creatinine and UNaK at baseline in youth referred for hypertensive disorders. Further characterization of the RAAS could help define hypertension phenotypes and guide management.

Graphical abstract

中文翻译：

高血压病患儿肾脏钠钾处理与肾素-血管紧张素-醛固酮系统的相关性

背景

尿钠和尿钾被用作成人高血压患者饮食摄入的替代指标，但它们在青少年高血压患者中的作用及其与肾素-血管紧张素-醛固酮系统 (RAAS) 成分的关联尚未完全表征。一些高血压患者可能对饮食中的钠和钾摄入量有异常的 RAAS 反应，尽管对此的描述不完整。我们的目的是调查血浆肾素活性和血清醛固酮是否与因高血压疾病转诊的青年人的尿钠和尿钾有关。

方法

这项试点研究是对 44 名在高血压门诊接受高血压疾病评估的青少年的基线数据的横断面分析。我们记录了根据尿肌酐、血浆肾素活性和血清醛固酮标准化的尿钠和钾浓度，并计算了钠/钾 (UNaK) 和醛固酮/肾素比率。我们使用多变量广义线性模型来估计肾素和醛固酮与尿钠和尿钾的关联。

结果

我们的队列多元化（37% 非西班牙裔黑人，14% 西班牙裔），66% 为男性，中位年龄为 15.3 岁；77% 有肥胖症，9% 有继发性病因。醛固酮与尿钠/肌酐（ β：-0.34，95% CI -0.62 至 -0.06）和 UNaK（β：-0.09，95% CI -0.16 至 -0.03）呈负相关，并根据估计的肾小球滤过率和血清钾。