Chen JL, Wang L, Yao XM, et al. - Researchers analyzed a large group of patients with nephrotic syndrome (NS) from various causes to determine the link between urinary plasmin and clinical phenotypes, and ultimately evaluate the role of urinary plasmin in sodium handling and edema formation. Based on edema severity, they grouped 203 patients with NS and urine and blood samples into mild and severe symptom groups. They assayed plasminogen-plasmin level and other key parameters, and assessed associations with clinical manifestations. The identified independent risk factors for edema included urinary plasminogen-plasmin to creatinine ratio (uPLG-PL/C), serum albumin, D-Dimer, and cardiac dysfunction history. In adult patients with NS, uPLG-PL abundance was identified as an independent influencing factor of edema. Findings also highlighted the significance of plasmin-dependent epithelial sodium channel activation as a pathophysiological mechanism of sodium retention and edema formation in humans with NS.