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Increased Soluble Leptin Receptor in Children with Nephrotic Syndrome

Klinik mit Poliklinik für Kinder und Jugendliche (M.S., M.G., M.R., W.R., J.D.), Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91054 Erlangen, Germany; and Institute of Laboratory Medicine (J.K.), Clinical Chemistry and Molecular Diagnostics, Hospital for Children and Adolescents, University of Leipzig, D-04103 Leipzig, Germany

Address all correspondence and requests for reprints to: Michael Schroth, M.D., Klinik mit Poliklinik für Kinder und Jugendliche Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, D-91054 Erlangen, Germany. E-mail: michael_schroth{at}yahoo.de.

In patients with nephrotic syndrome, severe proteinuria is related to significant leptinuria; serum leptin levels remain unchanged. The goal of this study was to elucidate the role of the soluble leptin receptor (sOB-R) in maintaining serum leptin levels in nephrotic patients. Patients with proteinuria were compared with patients in remission of nephrotic syndrome. In this group proteinuria did not exceed 100 mg/m² of body surface area per day. The period of remission was at least 6 months and was equal in all patients included. The sOB-R level (mean ± SD) in serum of patients with nephrotic syndrome was significantly higher during proteinuria (61.0 ± 17.8 ng/ml) than those in remission or in control patients (36.7 ± 7.0 ng/ml, 36.6 ± 12.0 ng/ml, respectively, P < 0.0001). The ratio between serum leptin levels and the sOB-R (free leptin index) was significantly lower in the proteinuric group (0.012 ± 0.005 vs. 0.06 ± 0.03 and 0.07 ± 0.03 in remission and control group, respectively) (P < 0.001). Urinary sOB-R excretion was similar in all groups. Our data suggest that the counteracting pathway in case of leptin loss in parallel to severe proteinuria in nephrotic syndrome is the up-regulation of its soluble binding protein in serum, which can keep total serum leptin levels constant.

Abbreviations: BMI, Body mass index; FLI, free leptin index; NS, nephrotic syndrome; sOB-R, soluble leptin receptor.

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