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Urinary protein markers predict the severity of renal histological lesions in children with mesangial proliferative glomerulonephritis.

Li Y, Wang J, Zhu X, Feng Q, Li X, Feng X - BMC Nephrol (2012)

Bottom Line: Mesangial proliferative glomerulonephritis (MesPGN) is characterized by proliferations of mesangial cells with increase in mesangial matrix and/or deposits in mesangial region.The urine proteins, as independent factors associated with severe mesangial cellularity (> 5 mesangial cells/ mesangial area) were transferrin, albumin, α1-microglobulin, IgG and 24-hour total protein, with severe glomerulosclerosis (≥ 10 % glomeruli showing segmental adhesions or sclerosis) were transferrin and 24-hour total protein, and with severe tubule-interstitial damage (focal or diffuse tubular and interstitial lesions) were transferrin and N-acetyl-β-glucosaminidase.Urinary N-acetyl-β-glucosaminidase achieved the highest AUC of 0.82 for predicting severe tubule-interstitial damage.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of nephrology, Children's Hospital of Soochow University, Suzhou, China.

ABSTRACT

Background: Several renal histopathological features, including mesangial hypercellularity, glomerulosclerosis, tubular atrophy and interstitial fibrosis, are considered to be independent predictors of end-stage renal failure in patients with glomerular diseases. Mesangial proliferative glomerulonephritis (MesPGN) is characterized by proliferations of mesangial cells with increase in mesangial matrix and/or deposits in mesangial region. The purpose of this study is to determine the association between urinary protein markers measured at the same time as renal biopsy and the severity of renal histological lesions in children with MesPGN, and to evaluate whether these markers could serve as predictors of severe renal histological lesions in this population.

Methods: Ninety-eight children with MesPGN (40 with IgA nephropathy, 37 with IgM nephropathy, and 21 with MesPGN without IgA/IgM deposition) were enrolled. Urinary level of IgG, albumin, transferrin, α1-microglobulin, β2-microglobulin and N-acetyl-β-glucosaminidase from a morning sample before biopsy was measured.The scores of mesangial hypercellularity, glomerulosclerosis, and tubule-interstitial damage were used to semi-quantitatively evaluate renal histological lesions.

Results: The urine proteins, as independent factors associated with severe mesangial cellularity (> 5 mesangial cells/ mesangial area) were transferrin, albumin, α1-microglobulin, IgG and 24-hour total protein, with severe glomerulosclerosis (≥ 10 % glomeruli showing segmental adhesions or sclerosis) were transferrin and 24-hour total protein, and with severe tubule-interstitial damage (focal or diffuse tubular and interstitial lesions) were transferrin and N-acetyl-β-glucosaminidase. Urinary transferrin achieved the area under-the-receiver-operating-characteristic curve (AUC) of 0.86 and 0.82, respectively, for predicting severe mesangial cellularity and glomerulosclerosis. Urinary N-acetyl-β-glucosaminidase achieved the highest AUC of 0.82 for predicting severe tubule-interstitial damage. The combination of urinary protein markers, however, did not improve the predictability for renal histological lesions.

Conclusions: Urinary protein markers are useful to predict the severity of renal histological lesions in children with MesPGN, which suggests that urinary proteins might be useful to predict the development and progression of renal histological lesions, and assist in evaluating the outcome and prognosis in children with MesPGN as non-invasive and easily repeatable indicators on the follow-up examination.

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Comparison of urinary protein markers between children with mild and severe renal histological lesions. Comparison of urinary proteins between children with severe mesangial cellularity (MC) defined as > 5 mesangial cells/ mesangial area (score ≥ 2, n = 34) and those with mild MC (score < 2, n = 64); between children with severe glomerulosclerosis (GS) defined as ≥ 10 % glomeruli showing segmental adhesions or sclerosis (score ≥ 2, n = 17) and those with mild GS (score < 2, n = 81); and between children with severe tubule-interstitial damage (TID) defined as focal or diffuse tubular and interstitial lesions (score ≥ 2, n = 20) and those with mild TID (score < 2, n = 78). Urinary excretion of IgG (A), albumin (B), transferrin (C), NAG (D), α1-microglobulin (E) and β2-microglobulin (F) was log transformed. Values are medians, boxes represent interquartile range, whiskers indicate smallest and largest non-outlier observation, and circles indicate outliers. Probability values: two-sample Kolmogorov-Smirnov test, *p < 0.05.
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Figure 1: Comparison of urinary protein markers between children with mild and severe renal histological lesions. Comparison of urinary proteins between children with severe mesangial cellularity (MC) defined as > 5 mesangial cells/ mesangial area (score ≥ 2, n = 34) and those with mild MC (score < 2, n = 64); between children with severe glomerulosclerosis (GS) defined as ≥ 10 % glomeruli showing segmental adhesions or sclerosis (score ≥ 2, n = 17) and those with mild GS (score < 2, n = 81); and between children with severe tubule-interstitial damage (TID) defined as focal or diffuse tubular and interstitial lesions (score ≥ 2, n = 20) and those with mild TID (score < 2, n = 78). Urinary excretion of IgG (A), albumin (B), transferrin (C), NAG (D), α1-microglobulin (E) and β2-microglobulin (F) was log transformed. Values are medians, boxes represent interquartile range, whiskers indicate smallest and largest non-outlier observation, and circles indicate outliers. Probability values: two-sample Kolmogorov-Smirnov test, *p < 0.05.

Mentions: As shown in Figure 1, there was a significantly higher urinary level of IgG, albumin, transferrin, α1-microglobulin and NAG in children with severe MC (score ≥ 2) when compared with children with mild MC (score < 2). The urinary level of IgG, albumin and transferrin in children with severe glomerulosclerosis (score ≥ 2) was significantly higher in comparison to children with glomerulosclerosis score < 2. The urinary level of IgG, albumin, transferrin and NAG was also significantly higher in children with severe TID (score ≥ 2), as compared to children without or with mild TID (score < 2). In Figure 1, data were log transformed.


Urinary protein markers predict the severity of renal histological lesions in children with mesangial proliferative glomerulonephritis.

Li Y, Wang J, Zhu X, Feng Q, Li X, Feng X - BMC Nephrol (2012)

Comparison of urinary protein markers between children with mild and severe renal histological lesions. Comparison of urinary proteins between children with severe mesangial cellularity (MC) defined as > 5 mesangial cells/ mesangial area (score ≥ 2, n = 34) and those with mild MC (score < 2, n = 64); between children with severe glomerulosclerosis (GS) defined as ≥ 10 % glomeruli showing segmental adhesions or sclerosis (score ≥ 2, n = 17) and those with mild GS (score < 2, n = 81); and between children with severe tubule-interstitial damage (TID) defined as focal or diffuse tubular and interstitial lesions (score ≥ 2, n = 20) and those with mild TID (score < 2, n = 78). Urinary excretion of IgG (A), albumin (B), transferrin (C), NAG (D), α1-microglobulin (E) and β2-microglobulin (F) was log transformed. Values are medians, boxes represent interquartile range, whiskers indicate smallest and largest non-outlier observation, and circles indicate outliers. Probability values: two-sample Kolmogorov-Smirnov test, *p < 0.05.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3403987&req=5

Figure 1: Comparison of urinary protein markers between children with mild and severe renal histological lesions. Comparison of urinary proteins between children with severe mesangial cellularity (MC) defined as > 5 mesangial cells/ mesangial area (score ≥ 2, n = 34) and those with mild MC (score < 2, n = 64); between children with severe glomerulosclerosis (GS) defined as ≥ 10 % glomeruli showing segmental adhesions or sclerosis (score ≥ 2, n = 17) and those with mild GS (score < 2, n = 81); and between children with severe tubule-interstitial damage (TID) defined as focal or diffuse tubular and interstitial lesions (score ≥ 2, n = 20) and those with mild TID (score < 2, n = 78). Urinary excretion of IgG (A), albumin (B), transferrin (C), NAG (D), α1-microglobulin (E) and β2-microglobulin (F) was log transformed. Values are medians, boxes represent interquartile range, whiskers indicate smallest and largest non-outlier observation, and circles indicate outliers. Probability values: two-sample Kolmogorov-Smirnov test, *p < 0.05.
Mentions: As shown in Figure 1, there was a significantly higher urinary level of IgG, albumin, transferrin, α1-microglobulin and NAG in children with severe MC (score ≥ 2) when compared with children with mild MC (score < 2). The urinary level of IgG, albumin and transferrin in children with severe glomerulosclerosis (score ≥ 2) was significantly higher in comparison to children with glomerulosclerosis score < 2. The urinary level of IgG, albumin, transferrin and NAG was also significantly higher in children with severe TID (score ≥ 2), as compared to children without or with mild TID (score < 2). In Figure 1, data were log transformed.

Bottom Line: Mesangial proliferative glomerulonephritis (MesPGN) is characterized by proliferations of mesangial cells with increase in mesangial matrix and/or deposits in mesangial region.The urine proteins, as independent factors associated with severe mesangial cellularity (> 5 mesangial cells/ mesangial area) were transferrin, albumin, α1-microglobulin, IgG and 24-hour total protein, with severe glomerulosclerosis (≥ 10 % glomeruli showing segmental adhesions or sclerosis) were transferrin and 24-hour total protein, and with severe tubule-interstitial damage (focal or diffuse tubular and interstitial lesions) were transferrin and N-acetyl-β-glucosaminidase.Urinary N-acetyl-β-glucosaminidase achieved the highest AUC of 0.82 for predicting severe tubule-interstitial damage.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of nephrology, Children's Hospital of Soochow University, Suzhou, China.

ABSTRACT

Background: Several renal histopathological features, including mesangial hypercellularity, glomerulosclerosis, tubular atrophy and interstitial fibrosis, are considered to be independent predictors of end-stage renal failure in patients with glomerular diseases. Mesangial proliferative glomerulonephritis (MesPGN) is characterized by proliferations of mesangial cells with increase in mesangial matrix and/or deposits in mesangial region. The purpose of this study is to determine the association between urinary protein markers measured at the same time as renal biopsy and the severity of renal histological lesions in children with MesPGN, and to evaluate whether these markers could serve as predictors of severe renal histological lesions in this population.

Methods: Ninety-eight children with MesPGN (40 with IgA nephropathy, 37 with IgM nephropathy, and 21 with MesPGN without IgA/IgM deposition) were enrolled. Urinary level of IgG, albumin, transferrin, α1-microglobulin, β2-microglobulin and N-acetyl-β-glucosaminidase from a morning sample before biopsy was measured.The scores of mesangial hypercellularity, glomerulosclerosis, and tubule-interstitial damage were used to semi-quantitatively evaluate renal histological lesions.

Results: The urine proteins, as independent factors associated with severe mesangial cellularity (> 5 mesangial cells/ mesangial area) were transferrin, albumin, α1-microglobulin, IgG and 24-hour total protein, with severe glomerulosclerosis (≥ 10 % glomeruli showing segmental adhesions or sclerosis) were transferrin and 24-hour total protein, and with severe tubule-interstitial damage (focal or diffuse tubular and interstitial lesions) were transferrin and N-acetyl-β-glucosaminidase. Urinary transferrin achieved the area under-the-receiver-operating-characteristic curve (AUC) of 0.86 and 0.82, respectively, for predicting severe mesangial cellularity and glomerulosclerosis. Urinary N-acetyl-β-glucosaminidase achieved the highest AUC of 0.82 for predicting severe tubule-interstitial damage. The combination of urinary protein markers, however, did not improve the predictability for renal histological lesions.

Conclusions: Urinary protein markers are useful to predict the severity of renal histological lesions in children with MesPGN, which suggests that urinary proteins might be useful to predict the development and progression of renal histological lesions, and assist in evaluating the outcome and prognosis in children with MesPGN as non-invasive and easily repeatable indicators on the follow-up examination.

Show MeSH
Related in: MedlinePlus