Chen JL, et al. - In an extensive group of patients (n=203) with nephrotic syndrome (NS) from multiple causes, researchers focused on the role of urinary plasmin in sodium handling and edema formation. For this purpose, they examined the link between urinary plasmin and clinical phenotypes. The independent risk factors for edema, identified in quantitative comparison and multivariate logistic regression analysis, were urinary plasminogen-plasmin to creatinine ratio (uPLG-PL/C), serum albumin, D-Dimer, and cardiac dysfunction history, but not albuminuria or 24-h urine protein. A close link between uPLG-PL and ENaC (epithelial sodium channel) activation was indicated. In adult NS patients, uPLG-PL abundance was identified as an independent influencing factor of edema. In humans with NS, plasmin-dependent ENaC activation was shown to be a significant pathophysiological mechanism of sodium retention and edema formation.