Effects of posture on creatinine clearance and urinary protein excretion in patients with various renal diseases

To investigate the effects of a change in posture on renal function, we measured Ccr and the urinary excretion of protein, albumin, immunoglobulin G (IgG) and transferrin in 80 patients with renal disease and in 9 healthy controls. Patients and controls were studied serially while supine for 60 min; then after standing upright for 60 min. Almost all subjects showed a drop in the Ccr with standing (p < 0.01). The percent change in Ccr after standing was more remarkable in patients with glomerulonephritis vs the healthy subjects (74.0 +/- 21.9% vs 89.9 +/- 12.3%, p < 0.01). The change in urinary excretion of protein and albumin after standing in patients with membranous nephropathy (MN-N) significantly exceeded that in patients with IgA nephropathy (IgA-N) (182.1 +/- 89.3% vs 108.1 +/- 59.2% in urinary protein and 181.7 +/- 98.7% vs 113.3 +/- 40.9% in urinary albumin, p < 0.01). Urinary excretion of IgG and transferrin tended to increase after standing in those two groups, but not significantly. Results indicate that posture affects urinary protein excretion, probably via an increase of glomerulocapillary hydrostatic pressure and/or change in the permeability of the glomerular capillary walls. We recommend that comparable postures should be used when protein excretion is used as a diagnostic tool and in monitoring structural damage to glomeruli, particularly in patients with membranous nephropathy.