Renin-angiotensin-aldosterone system in nephrotic syndrome.

Previous studies on the renin-angiotensin-aldosterone system and fluid volumes in patients with nephrotic syndrome have not considered the nature of the underlying renal lesion. We compared plasma renin concentration (PRC), plasma aldosterone (PA), and plasma volume in three groups of patients: five nephrotic patients with minimal change disease on renal biopsy, seven nephrotic patients with other renal histopathology, and a control group of eight patients investigated for glomerulonephritis with no past or present nephrosis. PRC and PA were significantly greater in nephrotic patients with minimal change disease than other renal histopathology (Supine PRC 42 +/- 7 microIU/mL compared with 14 +/- 4, P less than 0.01; ambulant PRC 56 +/- 7 microIU/mL compared with 29 +/- 10, P less than 0.05; supine PA 158 +/- 55 pg/mL compared with 53 +/- 13, P less than 0.05; and ambulant PA 167 +/- 57 pg/mL compared with 29 +/- 10, P less than 0.05. Plasma volume was similar in all three groups, contrary to predictions from the Starling capillary fluid exchange hypothesis. Nephrosis may be characterized by different pathophysiologic groups according to the underlying renal histopathology. High plasma renin and aldosterone levels may be markers for minimal change disease.