Prognostic value of tubular proteinuria and enzymuria in nonoliguric acute tubular necrosis
Prognostic value of tubular proteinuria and enzymuria in nonoliguric acute tubular necrosis
复制标题
DOI：
10.1373/clinchem.2003.027763
复制
发表时间：
2004-03-01
影响因子：
9.3
通讯作者：
Kribben, A
中科院分区：
文献类型：
--
作者：
Herget-Rosenthal, S;Poppen, D;Kribben, A
背景：急性肾小管坏死（ATN）具有很高的死亡率，特别是需要肾替代治疗（RRT）的患者。我们前瞻性地研究了尿中低分子量蛋白和酶的排泄作为ATN患者需要RRT的预测指标的诊断准确性。方法：在73例连续的非低尿酸ATN患者中，我们测量了ATN早期尿中α(1)-和β(2)-微球蛋白、胱抑素C、视黄醇结合蛋白、α -谷胱甘肽s -转移酶、γ -谷氨酰基转移酶、乳酸脱氢酶和n -乙酰- β - d -氨基葡萄糖苷酶的排泄量。结果：26例患者（36%）在检测到蛋白尿和酶血症后需要RRT，中位时间为4天（四分位数间距，2-6天）。需要RRT的患者尿胱抑素C和α(1)-微球蛋白[中位数（四分位数范围），1.7（1.2-4.1）和34.5 (26.6-45.1)g/mol肌酐]高于不需要RRT的患者[0.1（0.02-0.5）和8.0 (5.0-17.5)g/mol肌酐]。尿胱抑素C和微球蛋白a在识别需要RRT的患者方面具有最高的诊断准确性，ROC曲线下的最大面积分别为0.92（95%可信区间为0.86-0.96）和0.86（0.78-0.92）。测定尿胱抑素C > 1 g/mol肌酐的灵敏度和特异性分别为92%（95%置信区间为83 ~ 96%）和83%(73 ~ 90%)，测定尿α(1)-微球蛋白>20 g/mol肌酐的灵敏度和特异性分别为88%（78 ~ 93%）和81%（70 ~ 88%）。结论：在非少尿型ATN中，尿中胱抑素C和α(1)-微球蛋白的增加可能预示着不利的结果，正如RRT的需求所反映的那样。(C) 2004美国临床化学学会。
Background: Acute tubular necrosis (ATN) has high mortality, especially in patients who require renal replacement therapy (RRT). We prospectively studied the diagnostic accuracy of the urinary excretion of low-molecular-weight proteins and enzymes as predictors of a need for RRT in ATN.Methods: In 73 consecutive patients with initially nonoliguric ATN, we measured urinary excretion of alpha(1)- and beta(2)-microglobulin, cystatin C, retinol-binding protein, alpha-glutathione S-transferase, gamma-glutamyltransferase, lactate dehydrogenase, and N-acetyl-beta-D-glucosaminidase early in the course of ATN.Results: Twenty-six patients (36%) required RRT a median of 4 (interquartile range, 2-6) days after detection of proteinuria and enzymuria. Patients who required RRT had higher urinary cystatin C and alpha(1)-microglobulin [median (interquartile range), 1.7 (1.2-4.1) and 34.5 (26.6-45.1) g/mol of creatinine] than patients who did not require RRT [0.1 (0.02-0.5) and 8.0 (5.0-17.5) g/mol of creatinine]. Urinary excretion of cystatin C and a,microglobulin had the highest diagnostic accuracies in identifying patients requiring RRT as indicated by the largest areas under the ROC curves: 0.92 (95% confidence interval, 0.86-0.96) and 0.86 (0.78-0.92), respectively. Sensitivity and specificity were 92% (95% confidence interval, 83-96%) and 83% (73-90%), respectively, for urinary cystatin C > 1 g/mol of creatinine, and 88% (78-93%) and 81% (70-88%) for urinary alpha(1)-microglobulin >20 g/mol of creatinine.Conclusion: In nonoliguric ATN, increased urinary excretion of cystatin C and alpha(1)-microglobulin may predict an unfavorable outcome, as reflected by the requirement for RRT. (C) 2004 American Association for Clinical Chemistry.