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Nephrology Dialysis Transplantation, Vol 14, Issue 1 91-97, Copyright © 1999 by Oxford University Press

ORIGINAL ARTICLES

Acute heamodynamic and proteinuric effects of prednisolone in patients with a nephrotic syndrome

L Reichert, R Koene and J Wetzels
Department of Medicine, Division of Nephrology, University Hospital Nijmegen, Nijmegen, The Netherlands; Corresponding author at: Department of Medicine, Maaslandziekenhuis, PO Box 5500, 6130 MB Sittard, The Netherlands

Background: Administration of prednisolone causes an abrupt rise in proteinuria in patients with a nephrotic syndrome. Methods: To clarify the mechanisms responsible for this increasing proteinuria we have performed a placebo controlled study in 26 patients with a nephrotic syndrome. Systemic an renal haemodynamics and urinary protein excretion were measured after prednisolone and after placebo. Results: After i.v. administration of 125-150 mg prednisolone total proteinuria increased from 6.66±4.42 to 9.37±6.07 mg/min (P<0.001). By analysing the excretion of proteins with different charge and weight (albumin, transferrin, IgG, IgG4 and {beta}2-microglobulin) it became apparent that the increase of proteinuria was the result of a change in size selectivity rather than a change in glomerular charge selectivity or tubular protein reabsorption. Glomerular filtration rate rose from 83±34 ml to 95±43 ml/min (P<0.001) after 5 h, whereas effective renal plasma flow and endogenous creatinine clearance remained unchanged. As a result filtration fraction was increased, compatible with an increased glomerular pressure, which probably contributes to the size selectivity changes. Since corticosteroids affect both the renin-angiotensin system and renal prostaglandins, we have evaluated the effects of prednisolone on proteinuria after pretreatment with 3 months of the angiotensin-converting enzyme inhibitor lisinopril or after 2 weeks of the prostaglandin synthesis inhibitor indomethacin. Neither drug had any effect on prednisolone-induced increases of proteinuria. Conclusions: Prednisolone increases proteinuria by changing the size selective barrier of the glomerular capillary. Neither the renin-angiotensin axis nor prostaglandins seem to be involved in these effects of prednisone on proteinuria. Key words: angiotensin-converting enzyme; nephrotic syndrome; prednisolone; prostaglandins; proteinuria; urinary albumin excretion; urinary transferrin excretion
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