J Korean Med Sci. 2014;29 Suppl 2(Suppl 2):S123-30.

Urinary sodium excretion has positive correlation with activation of urinary renin angiotensin system and reactive oxygen species in hypertensive chronic kidney disease.

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제1저자 안신영 · 교신저자 진호준

PMID 25317016 PMC4194282 DOI 10.3346/jkms.2014.29.S2.S123 IF 3.2 신장내과

소속 (9)

Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. ; Department of Immunology, Seoul National University Postgraduate School, Seoul, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea.
Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, Korea.
Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
Research Institute of Salt and Health, Seoul, Korea. ; Seoul K-Clinic, Seoul, Korea.

Abstract

It is not well described the pathophysiology of renal injuries caused by a high salt intake in humans. The authors analyzed the relationship between the 24-hr urine sodium-to-creatinine ratio (24HUna/cr) and renal injury parameters such as urine angiotensinogen (uAGT/cr), monocyte chemoattractant peptide-1 (uMCP1/cr), and malondialdehyde-to-creatinine ratio (uMDA/cr) by using the data derived from 226 hypertensive chronic kidney disease patients. At baseline, the 24HUna/cr group or levels had a positive correlation with uAGT/cr and uMDA/cr adjusted for related factors (P<0.001 for each analysis). When we estimated uAGT/cr in the 24HUna/cr groups by ANCOVA, the uAGT/cr in patients with ≥200 mEq/g cr was higher than in patients with <100 mEq/g cr (708 [95% CI, 448-967] vs. 334 [95% CI, 184-483] pg/mg cr, P=0.014). Similarly, uMDA/cr was estimated as 0.17 (95% CI, 0.14-0.21) pM/mg cr in patients with <100 mEq/g cr and 0.27 (95% CI, 0.20-0.33) pM/mg cr in patients with ≥200 mEq/g cr (P=0.016). During the 16-week follow-up period, an increase in urinary sodium excretion predicted an increase in urinary angiotensinogen excretion. In conclusion, high salt intake increases renal renin-angiotensin-system (RAS) activation, primarily, and directly or indirectly affects the production of reactive oxygen species through renal RAS activation.

Keywords

AngiotensinogenChronic Renal InsufficiencyReninSodium Chloride

Figures

**Fig. 1** Urinary cytokines to creatinine ratio among 24HUna/cr groups. (A) AGT, angiotensinogen. (B) MCP1, monocyte chemoattractant protein-1. (C) MDA, malondialdehyde. 24HUna/cr, the ratio of 24-hr urine sodium to creatinine (mg/g creatinine). The P value was calculated by one-way ANOVA test. ^*Different from the group with 24HUna/cr<100 mEq/g cr. The bar means 95% confidence interval of each mean value.

**Fig. 2** The frequency of tertile groups of cytokines according to 24HUna/cr groups. The ratio of 24-hr urine sodium to creatinine (mg/g creatinine) by (A) uAGT/cr, urine angiotensinogen to creatinine ratio (pg/mg cr), (B) uMCP1/cr, urine monocyte chemoattractant protein-1 to creatinine ratio (pg/mg cr), (C) uMDA/cr: urine malondialdehyde to creatinine ratio (pM/mg cr).

**Fig. 3** The relationship between the changes of 24-hr urine cytokines to creatinine ratio and urine sodium to creatinine ratio during 16 weeks after ARB medication. Frequency of increase in cytokine level: Frequency of increase in 24-hr urinary cytokine to creatinine ratio at 16-week compared to 0-week 25% or more. Increased 24HUna/cr defined as increase of 24HUna/cr ratio 25% or more, Decreased 24HUna/cr defined as decrease of 24HUna/cr ratio 25% or more, and unchanged 24HUna/cr defined as the ratio of 24HUna/cr between -24.9% and 24.9%, at 16-week compared to 0-week. uAGT/Cr: 24-hr urine angiotensinogen to creatinine ratio (pg/mg cr), uMCP1/Cr: 24-hr urine monocyte chemoattractant protein-1 to creatinine ratio (pg/mg cr), uMDA/Cr: 24-hr urine malondialdehyde to creatinine ratio (pM/mg cr).

그림 출처: PubMed Central 공개 논문 (PMC4194282)

Conflict of interest statement

The authors have no conflicts of interest to disclose.

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