Key result
Pediatric idiopathic nephrotic syndrome was associated with increased urinary Ang II, Ang-(1-7), and ACE, and reduced ACE2, which negatively correlated with 24-h proteinuria.
Why the study?
Most studies have investigated only the classical RAS axis in idiopathic nephrotic syndrome, leaving urinary levels of classical and counter-regulatory RAS molecules and their associations with inflammation and proteinuria uncharacterized.
Are urinary levels of RAS molecules altered in pediatric patients with idiopathic nephrotic syndrome compared to healthy controls?
Cross-Sectional (n=50)
Are urinary levels of RAS molecules altered in pediatric patients with idiopathic nephrotic syndrome compared to healthy controls?
In pediatric patients with idiopathic nephrotic syndrome, proteinuria is associated with low urinary levels of ACE2 and high levels of inflammatory molecules.
Lower urinary ACE2 associates with proteinuria in pediatric INS; leaves open whether counter-regulatory RAS modulation affects outcomes.
Introduction: Renin angiotensin system (RAS) plays a role in idiopathic nephrotic syndrome (INS). Most studies investigated only the classical RAS axis. Therefore, the aims of the present study were to evaluate urinary levels of RAS molecules related to classical and to counter-regulatory axes in pediatric patients with INS, to compare the measurements with levels in healthy controls and to search for associations with inflammatory molecules, proteinuria and disease treatment. Subjects and methods: This cross-sectional study included 31 patients with INS and 19 healthy controls, matched for age and sex. Patients and controls were submitted to urine collection for measurement of RAS molecules [Ang II, Ang-(1-7), ACE and ACE2] by enzyme immunoassay and cytokines by Cytometric Bead Array. Findings in INS patients were compared according to proteinuria: absent (<150 mg/dl, n = 15) and present (≥150 mg/dl, n = 16). Results: In comparison to controls, INS patients had increased Ang II, Ang-(1-7) and ACE, levels while ACE2 was reduced. INS patients with proteinuria had lower levels of ACE2 than those without proteinuria. ACE2 levels were negatively correlated with 24-h-proteinuria. Urinary concentrations of MCP-1/CCL2 were significantly higher in INS patients, positively correlated with Ang II and negatively with Ang-(1-7). ACE2 concentrations were negatively correlated with IP-10/CXCL-10 levels, which, in turn, were positively correlated with 24-h-proteinuria. Conclusion: INS patients exhibited changes in RAS molecules and in chemokines. Proteinuria was associated with low levels of ACE2 and high levels of inflammatory molecules.
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Filha et al. (2018) conducted a cross-sectional in Idiopathic nephrotic syndrome (n=50). Idiopathic nephrotic syndrome vs. Healthy controls was evaluated on Urinary levels of RAS molecules and cytokines. Pediatric idiopathic nephrotic syndrome was associated with increased urinary Ang II, Ang-(1-7), and ACE, and reduced ACE2, which negatively correlated with 24-h proteinuria.
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