The Urinary Angiotensinogen to Urinary Albumin Ratio Reflects Whether the Renin-angiotensin System in the Kidney Is Activated due to Filtration of Plasma Angiotensinogen through the Damaged Glomeruli or the Production of Angiotensinogen in the Proximal Tubules

  • Ohashi Naro
    Internal Medicine 1, Hamamatsu University School of Medicine, Japan
  • Aoki Taro
    Internal Medicine 1, Hamamatsu University School of Medicine, Japan
  • Matsuyama Takashi
    Internal Medicine 1, Hamamatsu University School of Medicine, Japan
  • Ishigaki Sayaka
    Blood Purification Unit, Hamamatsu University School of Medicine, Japan
  • Isobe Shinsuke
    Internal Medicine 1, Hamamatsu University School of Medicine, Japan
  • Katahashi Naoko
    Internal Medicine 1, Hamamatsu University School of Medicine, Japan
  • Sato Taichi
    Internal Medicine 1, Hamamatsu University School of Medicine, Japan
  • Fujikura Tomoyuki
    Internal Medicine 1, Hamamatsu University School of Medicine, Japan
  • Kato Akihiko
    Blood Purification Unit, Hamamatsu University School of Medicine, Japan
  • Yasuda Hideo
    Internal Medicine 1, Hamamatsu University School of Medicine, Japan

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Abstract

<p>Objective Urinary angiotensinogen (AGT) is a surrogate marker for intrarenal renin-angiotensin system (RAS) activity that plays an important role in the development of renal damage. Urinary AGT levels are determined by the filtration of plasma AGT through the damaged glomeruli and production of AGT in the proximal tubules. However, the relative merits of the filtration and production of urinary AGT levels in chronic kidney diseases (CKD) have not been clarified. Therefore, we investigated them in CKD patients. </p><p>Methods We recruited 41 biopsy-proven patients diagnosed with IgA nephropathy (IgAN) in 31, membranous nephropathy (MN) in 5, and tubulointerstitial nephritis (TIN) in 5. The patients taking RAS blockers were excluded. </p><p>Results The urinary albumin levels in MN patients were significantly higher and those in TIN patients significantly lower than in IgAN patients, and the urinary AGT levels in the MN and TIN patients were significantly higher than those in IgAN patients. Conversely, the urinary AGT-to-urinary albumin (urinary AGT/Alb) ratios were the same for IgAN and MN patients, and those of TIN patients were significantly higher than those of IgAN and MN patients. A multiple linear regression analysis revealed that the urinary AGT/Alb ratios had a significant positive association with IgAN and TIN after adjustments (β=0.75, and p<0.01). </p><p>Conclusion These data suggest that the origins of urinary AGT may differ according to the etiology of renal damage [i.e. glomerular damage (such as IgAN and MN) or tubulointerstitial damage (such as TIN)], and a higher urinary AGT/Alb ratio, as in TIN, may reflect AGT production in the kidney. </p>

Journal

  • Internal Medicine

    Internal Medicine 59 (3), 357-364, 2020-02-01

    The Japanese Society of Internal Medicine

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