Clinical Investigation

Kidney International (1979) 16, 196–203; doi:10.1038/ki.1979.121

Renin-angiotensin-aldosterone system in the healthy infant and child

Karel J Van Acker1, Simon L Scharpe1, Andre J R Deprettere1 and Hugo M Neels1

1Department of Pediatrics and Department of Pharmaceutical Sciences, Universitaire Instelling Antwerpen, Belgium

Correspondence: Prof K J Van Acker, Universitaire Instelling Antwerpen, Universiteitsplein, 1, 2610 Wilrijk, Belgium.

Received 24 October 1978; Revised 6 February 1979.

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Abstract

Renin-angiotensin-aldosterone system in the healthy infant and child. Plasma renin activity (PRA), plasma aldosterone concentration (PAldo), and urinary aldosterone 18-oxoglucuronide excretion (UAldoV) were studied in 69 healthy children, aged 3 months to 15 years, in basic conditions. In 49 of them, PRA and PAldo were also measured after stimulation with oral furosemide and tilting. PRA, PAldo, and UAldo V showed a significant negative correlation with age (P < 0.001) and a greater variation in the youngest age groups. No correlation could be found between PRA or PAldo and the sodium excretion per kilogram of body weight per 24 hours for the total of subjects as well as within each age group. An age-independent correlation between PAldo, but not PRA, and urinary potassium was observed. After correction for age, there was no significant relationship between PRA and PAldo or between plasma sodium or potassium and PRA or PAldo. It is speculated that a lower sodium turnover, as evaluated from the sodium excretion, is probably not the most important cause of the increased PRA or PAldo values, at least within the range of sodium intake in these subjects. As suggested by the results of principal component analysis on correlation matrices, age (and height, surface area) seems to be the most important factor. By what mechanism this factor influences the renin-angiotensin-aldosterone system is at present unclear. Furthermore, in the younger children, the analysis suggests that variables other than age are also involved. After stimulation with furosemide and tilting, there was an increase of the mean PRA and PAldo values. The increase of percentage was greatest in the older age groups where the lowest basic values were found. A positive correlation was found between PRA and systolic as well as diastolic blood pressure: the correlation disappeared after correction for age.

Le système rénine-angiotensine-aldostérone chez l'enfant bien portant. L'activité rénine plasmatique (PRA), la concentration plasmatique d'aldostérone (PAldo), et l'excrétion urinaire de 18-oxoglucuronide d'aldostérone (UAldoV) ont été étudiées chez 69 enfants bien portants, âgés de 3 mois à 15 ans, dans des conditions basales. Chez 49 d'entre eux PRA et PAldo ont été mesurées aussi après stimulation par le furosémide per os et le changement de position. PRA, PAldo, et UAldoV sont négativement corrélées avec l'âge (P < 0,001) et la variation est plus grande dans les groupes d'âges les moins élevés. Il n'a pas été observé de corrélation entre PRA ou PAldo et l'excrétion de sodium par kilogram de poids corporel et par 24 heures, ni dans l'ensemble des sujets, ni dans les divers groupes d'âges. Une corrélation indépendante de l'âge a été observée entre PAldo, mais non PRA, et le potassium urinaire. Après correction pour l'âge, il n'y a pas de relation significative entre PRA et PAldo ni entre le sodium ou le potassium plasmatiques et PRA ou PAldo. Il est suggéré qu'un renouvellement faible du sodium, apprécié à partir de l'excrétion de sodium, n'est probablement pas la cause principale des valeurs élevées de PRA ou de PAldo, au moins dans l'éventail des ingestions de sodium de ces sujets. Comme il est suggéré par les résultats de l'analyse des composantes principales sur des matrices de corrélation, l'âge (ainsi que la taille et la surface corporelle) semble être le facteur le plus important. Les mécanismes par lesquels ces facteurs influencent le système rénine-angiotensine-aldostérone ne sont pas actuellement clairs. De plus, chez les enfants les plus jeunes, l'analyse suggère que d'autres variables que l'âge sont impliquées. Après stimulation par le furosémide et le changement de position on observe une augmentation des valeurs moyennes de PRA et PAldo. L'augmentation en pourcentage est plus importante dans les groupes d'âges élevés, où les valeurs basales sont les plus basses. Il existe une corrélation positive entre PRA et la pression artérielle systolique et diastolique: cette corrélation disparaît après correction pour l'âge.

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