Plasma soluble (pro)renin receptor is independent of plasma renin, prorenin, and aldosterone concentrations but is affected by ethnicity.

A soluble (pro)renin receptor (sPRR) circulates in plasma and is able to bind renin and prorenin. It is not known whether plasma sPRR concentrations vary with the activity of the renin-angiotensin system. We measured plasma sPRR, renin, prorenin, and aldosterone concentrations in 121 white and 9 black healthy subjects, 40 patients with diabetes mellitus, 41 hypertensive patients with or without renin-angiotensin system blockers, 9 patients with primary aldosteronism, and 10 patients with Gitelman syndrome. Median physiological plasma sPRR concentration was 23.5 ng/mL (interquartile range, 20.9-26.5) under usual uncontrolled sodium diet. sPRR concentration in healthy subjects, unlike renin and prorenin, did not display circadian variation or dependence on age, sex, posture, or hormonal status. sPRR concentrations were ≈25% lower in black than in white subjects, whereas renin concentrations were ≈40% lower. Patients with diabetes mellitus (average renin-high prorenin levels) and with hypertension only (average renin-average prorenin levels) had sPRR concentrations similar to healthy subjects. Renin-angiotensin system blockade was associated with increase of sPRR concentration by ≈12%. sPRR in patients with primary aldosteronism (low renin-low prorenin) and Gitelman syndrome (high renin-high prorenin) were similar and ≈10% higher than in healthy subjects. There was no correlation between sPRR and renin or prorenin. In conclusion, our results show that plasma sPRR concentrations are dependent on ethnicity and independent of renin, prorenin, and aldosterone concentrations in healthy subjects and in patients with contrasted degrees of renin-angiotensin system activity.

Mass spectrometric quantification of AcSDKP-NH2 in human plasma and urine and comparison with an immunoassay.

RATIONALE: Precise assessment of renal glomerular filtration rate (GFR) is essential for the early detection of chronic kidney disease. AcSDKP-NH(2), an analogue of the endogenous tetrapeptide AcSDKP, is not degraded in vivo and is freely filtered by the kidney and eliminated in urine; for that reason this analogue is an ideal candidate marker for the assessment of GRF after administration to humans. Proof-of-concept demonstration and lack of toxicity in animals have allowed an ongoing clinical study in which AcSDKP-NH(2) was administered intravenously at a dose of 100 µg and compared with currently available GFR markers. The use of the AcSDKP analogue in clinical practice requires that this novel marker be associated with an analytical method that combines specificity, robustness and high accuracy. We have developed a liquid chromatography/tandem mass spectrometry (LC/MS/MS) assay and compared it with an existing enzyme immunoassay (EIA) for AcSDKP-NH(2). METHODS: Human urine and plasma samples from the clinical study were analyzed by EIA and LC/MS/MS. Before LC/MS/MS assessment, AcSDKP-NH(2) was extracted using mixed-mode cation-exchange solid-phase extraction cartridges. Chromatographic separation was performed by hydrophilic interaction liquid chromatography (HILIC), before analysis with an electrospray ionization triple quadrupole mass spectrometer. RESULTS: Mass spectrometry, through the use of an internal standard, tailored sample preparation and chromatographic separation, has better intra- and inter-assay precision (accuracies between 95 and 101% with CVs <8% for LC/MS/MS vs. accuracies between 90 and 115% with CVs <18% for EIA) and allows greater steadiness in intra-subject concentrations during the infusion (4.4% for LC/MS/MS vs. 8.6% for EIA). Moreover, the LC/MS/MS assay circumvents matrix effects observed in certain instances for the EIA and which may reduce its accuracy. CONCLUSIONS: Although the EIA can provide sufficient information in most subjects, the LC/MS/MS assay associated with this new marker should be the reference method.