Tubular markers do not predict the decline in glomerular filtration rate in type 1 diabetic patients with overt nephropathy
Tubular markers do not predict the decline in glomerular filtration rate in type 1 diabetic patients with overt nephropathy
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DOI：
10.1038/ki.2010.554
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发表时间：
2011-05-01
影响因子：
19.6
通讯作者：
Rossing, Peter
中科院分区：
文献类型：
--
作者：
Nielsen, Stine E.;Andersen, Steen;Rossing, Peter
近年来的研究表明，肾小球和肾小管间质损害是糖尿病肾病病理生理和进展的重要因素。为了检测肾小管损伤标志物是否可用于监测疾病进展，我们在一项为期3年的干预研究中对63例1型糖尿病肾病患者进行了中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肝脂肪酸结合蛋白（LFABP）和肾损伤分子-1（KIM-1）的尿水平测定。基线平均肾小球滤过率（GFR）为87 ml/min/1.73 m2，尿白蛋白排泄量为1141 mg/24 h。基线时尿NGAL水平最高与最低四分位数相比的患者，尿KIM-1水平较高，GFR每年显著降低。使用线性回归分析，我们发现尿NGAL和KIM-1浓度升高与GFR下降更快相关，但在调整已知的进展促进因素后则不相关。尿LFABP与GFR下降无关。氯沙坦治疗（100 mg/天）在12个月内使尿KIM-1减少了43%。因此，1型糖尿病肾病患者的尿液生物标志物测量并没有提供已知进展促进剂的额外预后信息。Kidney International（2011）79，1113-1118; doi：10.1038/ki.2010.554; 2011年1月26日在线发表
Recent studies have shown that both glomerular and tubulointerstitial damage are important factors in the pathophysiology and progression of diabetic nephropathy. To examine whether markers of tubular damage are useful in monitoring the progression of disease, we measured urinary levels of neutrophil gelatinase-associated lipocalin (NGAL), liver-fatty acid-binding protein (LFABP), and kidney injury molecule-1 (KIM-1) in a 3-year intervention study of 63 type 1 diabetic patients with kidney disease. The baseline mean glomerular filtration rate (GFR) was 87 ml/min per 1.73m(2) and urinary albumin excretion 1141mg/24 h. Patients with the highest compared with the lowest quartile of urinary NGAL at baseline had higher urinary KIM-1 levels and a significant decrease in their GFR each year. Using linear regression analysis, we found that elevated urinary NGAL and KIM-1 concentrations were associated with a faster decline in GFR, but not after adjustment for known promoters of progression. Urinary LFABP was not related to decline in GFR. Losartan treatment (100mg/day) reduced urinary KIM-1 by 43% over a 12-month period. Thus, urine biomarker measurements in patients with type 1 diabetic nephropathy did not provide additional prognostic information to that of known progression promoters. Kidney International (2011) 79, 1113-1118; doi:10.1038/ki.2010.554; published online 26 January 2011