Classification of Renal Proteinuria: A Simple Algorithm
Classification of Renal Proteinuria: A Simple Algorithm
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DOI：
10.1515/cclm.2002.201
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发表时间：
2002-12-01
影响因子：
6.8
通讯作者：
Bergon, Marta
中科院分区：
文献类型：
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作者：
Bergon, Enrique;Granados, Rosario;Bergon, Marta
对 1622 份尿样中的总蛋白、白蛋白、α(1)-微球蛋白和免疫球蛋白 G (IgG) 进行了分析，无 Bence-Jones 蛋白尿或肉眼血尿。与 61 名患者肾活检获得的组织学图像相关。我们对 659 个尿样建立了 α(1)-微球蛋白和 IgG 的 24 小时参考区间，总蛋白和白蛋白排泄率分别低于 100 mg/24 h 和 30 mg/24 h，肌酐清除率高于 80 ml/min。 α(1)-微球蛋白的中心 95% 参考区间为 4 至 17 mg/24 小时，IgG 的中心 95% 参考区间为 3 至 8.5 mg/24 小时。在80份白蛋白排泄率高于30 mg/24 h且α(1)-微球蛋白和IgG在参考区间内的尿液样本中，我们分析了IgG/白蛋白比值分布的95%中心区间，发现其在0.01和0.20之间（0.90置信区间：0.17 -0.24）。如果白蛋白排泄率异常且IgG/白蛋白比值低于0.20，即使IgG排泄在病理范围内，也可认为是选择性肾小球型蛋白尿。为了将蛋白尿主要分类为管状蛋白尿，我们估计了 173 个尿液样本中的 α(1)-微球蛋白/白蛋白比率，其中白蛋白和 IgG 排泄率正常，α(1)-微球蛋白病理性排泄。接受判别值 0.91（0.90 置信区间：0.78-1.08），以便在存在病理性白蛋白排泄率的情况下定义肾小管起源的蛋白尿。白蛋白和 IgG 排泄率与正常情况下由肾小球过滤的 (α(1)-微球蛋白) 肾小管重吸收之间的关联在 33 份尿液样本中进行了研究，这些样本取自无组织学上显着的肾小管间质或血管疾病且血清肌酐浓度低于 141 pmol/l 的患者。白蛋白加 IgG 与 (α(1)-微球蛋白排泄率之间的最佳曲线拟合函数为二次型(r= 0.927)。当白蛋白和α(1)-微球蛋白排泄率均为病理性并且不能包含在先前描述的组中时，考虑混合性蛋白尿。
Total protein, albumin, alpha(1)-microglobulin, and immunoglobulin G (IgG) were analyzed in 1622 urine samples without Bence-Jones proteinuria or gross hematuria. There was correlation with the histological picture obtained on renal biopsy in 61 patients. We established 24-h reference intervals for alpha(1)-microglobulin and IgG on 659 urine samples with total protein and albumin excretion rates below 100 mg/24 h and 30 mg/24 h, respectively, and creatinine clearance above 80 ml/min. The central 95% reference interval was found to be between 4 and 17 mg/24 h for alpha(1)-microglobulin and between 3 and 8.5 mg/24 h for IgG. In 80 urine samples with albumin excretion rate above 30 mg/24 h and alpha(1)-microglobulin and IgG within their reference intervals, we analyzed the 95% central interval of the distribution of the IgG/albumin ratios, and it was found to be within 0.01 and 0.20 (0.90 confidence interval: 0.17 -0.24). Proteinuria was considered to be of the selective glomerular type if the albumin excretion rate was abnormal and the IgG/albumin ratio was under 0.20, even when the IgG excretion was within a pathological range. For the classification of proteinuria as predominantly tubular, we estimated the alpha(1)-microglobulin/albumin ratio in 173 urine samples with normal excretion rates of albumin and IgG and pathological excretion of alpha(1)-microglobulin. The discriminating value of 0.91 (0.90 confidence interval: 0.78-1.08) was accepted in order to define proteinuria of a tubular origin in the presence of a pathological albumin excretion rate. The association between albumin and IgG excretion rates and tubular reabsorption of the (alpha(1)-microglobulin normally filtered by the glomerulus was studied in 33 urine samples from patients with no histologically significant tubulo-interstitial or vascular disease and a serum creatinine concentration below 141 pmol/l. The optimal curve-fitting function between albumin plus IgG and (alpha(1)-microglobulin excretion rates was of the quadratic type (r= 0.927). Mixed proteinuria was considered when both, albumin and alpha(1)-microglobulin excretion rates were pathological and could not be included in the previously described groups.