RENAL SODIUM RETENTION DURING VOLUME EXPANSION IN EXPERIMENTAL NEPHROTIC SYNDROME

Sodium retention was studied during volume expansion in rats with autologous immune complex nephropathy (AICN), a model of nephrotic syndrome (NS) in which GFR after volume expansion was not different from that in adjuvant-injected controls (C). AICN rats developed heavy proteinuria (298 ± 27 vs. <10 mg/day), hypoalbuminemia (2.14 ± 0.15 vs. 3.08 ± 0.12 g/100 ml) and hypercholesterolemia (181 ± 22 vs. 58 ± 4 mg/100 ml). After saline, there were no significant differences in blood pressure (119 ± 2 vs. 114 ± 2 mm Hg), renal plasma flow (4.9 ± 0.41 vs. 4.1 ± 0.28 ml/min), inulin clearance (1.37 ± 0.06 vs. 1.55 ± 0.10 ml/min), or SNGFR (47 ± 2 vs. 53 ± 4 nl/min). Sodium excretion, however, was significantly lower in NS rats (4.7 ± 1.1 vs. 9.2 ± 1.2 μEq/min). Proximal sodium reabsorption was decreased in NS rats (35 ± 2 vs. 41 ± 2%, 2.5 ± 0.2 vs. 3.3 ± 0.2 nEq/min). Sodium delivery into the loop, however, was equal in NS and C, since the slightly lower filtered load in NS rats offset the depression in proximal reabsorption. Sodium reabsorption by the loop and by the distal convoluted tubules was equal in NS and C. Thus, sodium delivered into the cortical collecting ducts was the same in both groups (0.33 ± 0.17 vs. 0.34 ± 0.07 nEq/min; 4.5 ± 0.6% of filtered sodium vs. 4.4 ± 0.3%). The percent of filtered sodium excreted in the urine, however, was significantly lower in the NS rats, 2.18 ± 0.48% vs. 4.0 ± 0.58%. The authors conclude that antinatriuresis in this model of NS is determined beyond the superficial late distal convoluted tubule. The inability to excrete the sodium load during volume expansion is due to either enhanced reabsorption by the collecting duct or to abnormal function in deep nephrons.