Urinary excretion of β2-microglobulin and IgG predict prognosis in idiopathic membranous nephropathy:: A validation study
Urinary excretion of β2-microglobulin and IgG predict prognosis in idiopathic membranous nephropathy:: A validation study
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DOI：
10.1681/asn.2004040287
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发表时间：
2005-01-01
影响因子：
13.6
通讯作者：
Wetzels, JF
中科院分区：
文献类型：
--
作者：
Branten, AJW;du Buf-Vereijken, PW;Wetzels, JF
对特发性膜性肾病(IMN)患者预后的准确预测应该允许将免疫抑制治疗限制在ESRD风险最高的患者。在回顾研究的基础上，以往的研究表明，尿β2-微球蛋白(Ubeta2m)和免疫球蛋白G(UIg G)的排泄量是预测IMN患者肾功能不全的有用指标。阈值为0.5ug/min(Ubeta2m)和250 mg/24小时(UIg/24 h)已在一个新的、更大的患者队列中得到验证。从1995年起，57例IMN患者(男性38例，女性19例；年龄48+/-16岁)，肾病综合征，血清肌酐水平低于或等于1.5 mg/dl进行前瞻性研究。在基线时，进行标准化测量以确定肾功能和蛋白排泄。终点肾死亡定义为血肌酐超过1.5毫克/分升或血肌酐升高50%。平均(+/-SD)随访期53+/-23mo。到目前为止，25名患者(44%)已经到达终点肾死亡。多变量分析证实Ubeta2m是肾功能不全发展的最强独立预测因子。Ubeta2m的敏感度和特异度分别为88%和91%，UIgG的敏感度和特异度均为88%。当两种蛋白的排泄物相结合时，特异性提高到97%。结论：目前的数据验证了Ubeta2m和UIg G在预测IMN患者肾脏预后方面的准确性。这些标记物可用于指导开始免疫抑制治疗的决定。
An accurate prediction of the prognosis of patients with idiopathic membranous nephropathy (iMN) should allow restriction of immunosuppressive treatment to patients who are at highest risk for ESRD. On the basis of retrospective studies, it has previously been suggested that the urinary excretions of beta2-microglobulin (Ubeta2m) and IgG (UIgG) are useful predictors of renal insufficiency in patients with iMN. The threshold values of 0.5 mug/min (Ubeta2m) and 250 mg/24 h (UIgG) have been validated in a new and larger patient cohort. From 1995 onward, 57 patients with iMN (38 men, 19 women; age 48 +/- 16 yr), a nephrotic syndrome, and a serum creatinine level less than or equal to1.5 mg/dl were studied prospectively. At baseline, a standardized measurement was carried out to determine renal function and protein excretion. The end point renal death was defined as a serum creatinine exceeding 1.5 mg/dl or a rise of serum creatinine of >50%. Mean (+/-SD) follow-up was 53 +/- 23 mo. Thus far, 25 (44%) of the patients have reached the end point renal death. Multivariate analysis confirmed Ubeta2m as the strongest independent predictor for the development of renal insufficiency. Sensitivity and specificity were 88 and 91%, respectively, for Ubeta2m, and both were 88% for UIgG. When the excretions of both proteins were combined, specificity improved to 97%. It is concluded that the present data validate the accuracy of Ubeta2m and of UIgG in predicting renal outcome in patients with iMN. These markers can be used to guide decisions on the start of immunosuppressive treatment.