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Menchaca AD, Olutoye OO. Fetal Lower Urinary Tract Obstruction: Current Diagnostic and Therapeutic Strategies and Future Directions. Fetal Diagn Ther 2024:1-9. [PMID: 39068932 DOI: 10.1159/000540198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/29/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Fetal lower urinary tract obstruction (LUTO) is a rare congenital anomaly in which the bladder cannot empty properly. The clinical presentation is variable. On the severe end of the spectrum, the amniotic fluid index can be sufficiently low, resulting in fetal lung development that is incompatible with life outside the womb. The pressure in the urinary tract system can also result in severe damage to the kidney, resulting in renal failure in utero or in the first couple years of life. Therefore, much work has been done to determine which fetuses need intervention in utero to allow for survival outside of the womb and avoidance of end-stage renal disease. Multiple therapies have been developed to relieve the obstruction in utero with the mainstay being vesicoamniotic shunting and posterior urethral valve ablation. SUMMARY While much has been investigated to determine which fetuses would benefit from fetal intervention, the current indications are not without their flaws. This review describes the current indications and their shortcomings, as well as new experimental methods of determining need for intervention. Additionally, this review describes the milestone animal studies that established the challenges of current fetal interventions and the utility of an experimental valved shunt in sheep over the last 20 years. KEY MESSAGES Our understanding of LUTO and which fetuses benefit from in utero intervention has grown over the last 20 years. However, traditional markers have proven to be less predictive than previously thought, opening the door to exciting new advances. Vesicoamniotic shunting, while lifesaving, does not preserve bladder function and frequently dislodges. Animal studies over the last 20 years have established the utility of a valved shunt to maintain bladder function. Current advances are working to create such a shunt that can be percutaneously deployed and have greater adherence to the bladder wall to avoid dislodgement.
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Affiliation(s)
- Alicia D Menchaca
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA,
- Department of General Surgery, Indiana University, Indianapolis, Indiana, USA,
| | - Oluyinka O Olutoye
- Center for Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Chen Y, Chen L, Meng J, Zhang M, Xu Y, Fan S, Liang C, Liao G. Development and external validation of a nomogram for predicting renal function based on preoperative data from in-hospital patients with simple renal cysts. J Int Med Res 2022; 50:3000605221087042. [PMID: 35317643 PMCID: PMC8949791 DOI: 10.1177/03000605221087042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To develop and validate a nomogram for predicting renal dysfunction in patients with simple renal cysts (SRCs). Methods We performed a multivariable logistic regression analysis of an in-hospital retrospective cohort of patients with SRCs in the Urology Department of the First Affiliated Hospital of Anhui Medical University. For prognostic model development, 386 patients with SRCs were enrolled from January 2016 to December 2018. External validation was performed in 46 patients with SRCs from January 2019 to April 2019. The primary outcome was renal dysfunction. Results Patients were divided into normal or abnormal estimated glomerular filtration rate groups (293 vs. 93) based on the cut-off value of 90 mL/minute/1.73 m2. Logistical regression analysis determined that age, haemoglobin, globulin, and creatinine might be associated with renal dysfunction, and a novel nomogram was established. Calibration curves showed that the true prediction rate was 77.42%, and decision curve analysis revealed that the nomogram was more effective with threshold probabilities ranging from 0.1 to 0.8. The area under the curves were 0.829, 0.752, and 0.888 in the overall training, internal, and external validation cohorts, respectively. Conclusions We established a nomogram to predict the probability of developing renal dysfunction in patients with SRCs.
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Affiliation(s)
- Yiding Chen
- Department of Urology, 36639First Affiliated Hospital of Anhui Medical University, The First Affiliated Hospital of Anhui Medical University, Institute of Urology, Anhui Medical University, Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Anhui, China
| | - Lei Chen
- Department of Urology, 36639First Affiliated Hospital of Anhui Medical University, The First Affiliated Hospital of Anhui Medical University, Institute of Urology, Anhui Medical University, Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Anhui, China
| | - Jialin Meng
- Department of Urology, 36639First Affiliated Hospital of Anhui Medical University, The First Affiliated Hospital of Anhui Medical University, Institute of Urology, Anhui Medical University, Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Anhui, China
| | - Meng Zhang
- Department of Urology, 36639First Affiliated Hospital of Anhui Medical University, The First Affiliated Hospital of Anhui Medical University, Institute of Urology, Anhui Medical University, Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Anhui, China
| | - Yuchen Xu
- Department of Urology, 36639First Affiliated Hospital of Anhui Medical University, The First Affiliated Hospital of Anhui Medical University, Institute of Urology, Anhui Medical University, Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Anhui, China
| | - Song Fan
- Department of Urology, 36639First Affiliated Hospital of Anhui Medical University, The First Affiliated Hospital of Anhui Medical University, Institute of Urology, Anhui Medical University, Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Anhui, China
| | - Chaozhao Liang
- Department of Urology, 36639First Affiliated Hospital of Anhui Medical University, The First Affiliated Hospital of Anhui Medical University, Institute of Urology, Anhui Medical University, Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Anhui, China
| | - Guiyi Liao
- Department of Urology, 36639First Affiliated Hospital of Anhui Medical University, The First Affiliated Hospital of Anhui Medical University, Institute of Urology, Anhui Medical University, Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Anhui, China
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Ezuruike U, Blenkinsop A, Pansari A, Abduljalil K. Quantification of Fetal Renal Function Using Fetal Urine Production Rate and Its Reflection on the Amniotic and Fetal Creatinine Levels During Pregnancy. Front Pediatr 2022; 10:841495. [PMID: 35311050 PMCID: PMC8927781 DOI: 10.3389/fped.2022.841495] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
Adequate prediction of fetal exposure of drugs excreted by the kidney requires the incorporation of time-varying renal function parameters into a pharmacokinetic model. Published data on measurements of fetal urinary production rate (FUPR) and creatinine at various gestational ages were collected and integrated for prediction of the fetal glomerular filtration rate (GFR). The predicted GFR values were then compared to neonatal values recorded at birth. Collected data for FUPR across different gestational ages using both 3D (N = 517) and 2D (N = 845) ultrasound methods showed that 2D techniques yield significantly lower estimates of FUPR than 3D (p < 0.0001). A power law function was shown to best capture the change in FUPR with fetal age (FA) for both 2D ( F U P R 2 D ( m L min ) = 0 . 000169 FA 2 . 19 ); and 3D ( F U P R 3 D ( m L min ) = 3 . 21 × 1 0 - 7 FA 4 . 21 ) data. The predicted FUPR based on the observed 3D data was shown to be strongly linearly related (R 2 = 0.95) to measured values of amniotic creatinine concentration (N = 664). The FUPR3D data together with creatinine levels in the fetal urine and serum resulted in median predicted fetal GFR values of 0.47, 1.2, 2.5, and 4.9 ml/min at 23, 28, 33, and 38 weeks of fetal age (50% CV), respectively. These values are in good agreement with neonatal values observed immediately at birth. The derived FUPR and creatinine functions can be utilized to assess fetal renal maturation and predict fetal renal clearance.
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Affiliation(s)
| | | | - Amita Pansari
- Certara UK Limited (Simcyp Division), Sheffield, United Kingdom
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Meyer TW, Hostetter TH. Why Is the GFR So High?: Implications for the Treatment of Kidney Failure. Clin J Am Soc Nephrol 2021; 16:980-987. [PMID: 33303581 PMCID: PMC8216625 DOI: 10.2215/cjn.14300920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The high GFR in vertebrates obligates large energy expenditure. Homer Smith's teleologic argument that this high GFR was needed to excrete water as vertebrates evolved in dilute seas is outdated. The GFR is proportional to the metabolic rate among vertebrate species and higher in warm-blooded mammals and birds than in cold-blooded fish, amphibians, and reptiles. The kidney clearance of some solutes is raised above the GFR by tubular secretion, and we presume secretion evolved to eliminate particularly toxic compounds. In this regard, high GFRs may provide a fluid stream into which toxic solutes can be readily secreted. Alternatively, the high GFR may be required to clear solutes that are too large or too varied to be secreted, especially bioactive small proteins and peptides. These considerations have potentially important implications for the understanding and treatment of kidney failure.
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Affiliation(s)
- Timothy W. Meyer
- Departments of Medicine, Veterans Affairs Palo Alto Health Care System and Stanford University, Palo Alto, California
| | - Thomas H. Hostetter
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina,University of North Carolina Kidney Center, University of North Carolina, Chapel Hill, North Carolina
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Malamitsi-Puchner A, Briana DD, Kontara L, Boutsikou M, Baka S, Hassiakos D, Marmarinos A, Gourgiotis D. Serum Cystatin C in Pregnancies With Normal and Restricted Fetal Growth. Reprod Sci 2016; 14:37-42. [PMID: 17636214 DOI: 10.1177/1933719106298196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to investigate circulating levels of cystatin C (an important endogenous marker of renal function) in mothers, fetuses, and neonates from intrauterine growth-restricted (IUGR; characterized by impaired nephrogenesis) and appropriate-for-gestational-age (AGA) pregnancies. Serum cystatin C levels were measured by enzyme immunoassay in 40 parturients and their 20 IUGR (<or=3rd customized centile, due to gestational pathology) and 20 AGA fetuses and neonates on postnatal day 1 (N1) and 4 (N4). Comparatively, creatinine and urea concentrations were determined in the same samples. Fetal cystatin C levels were higher in the AGA than the IUGR group (P = .001). In both groups, maternal cystatin C levels were lower than fetal (P < .001), N1 (P < .001), and N4 (P < .001) levels. Fetal levels were higher than N1 (P < .001) and N4 (P < .001), and N1 levels were higher than N4 (P = .007) ones. In both groups, no correlation existed between maternal and fetal levels, but positive correlations were found between cystatin C, creatinine, and urea levels in maternal and neonatal samples (in all cases, r >or= 0.376 and P <or= .045). Cystatin C levels did not correlate with gestational age and did not differ between males and females. Fetal cystatin C serum levels are lower in the IUGR group, significantly decrease after birth, and do not correlate with maternal levels in both groups. In addition, serum cystatin C levels positively correlate with respective creatinine and urea levels in the perinatal period.
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Affiliation(s)
- Ariadne Malamitsi-Puchner
- Neonatal Division, Second Department of Obstetrics and Gynecology, Athens University Medical School, Athens, Greece. @aias.gr
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Beta-2 microglobulin-based equation for estimating glomerular filtration rates in Japanese children and adolescents. Clin Exp Nephrol 2014; 19:450-7. [DOI: 10.1007/s10157-014-1015-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
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Klein J, Lacroix C, Caubet C, Siwy J, Zurbig P, Dakna M, Muller F, Breuil B, Stalmach A, Mullen W, Mischak H, Bandin F, Monsarrat B, Bascands JL, Decramer S, Schanstra JP. Fetal Urinary Peptides to Predict Postnatal Outcome of Renal Disease in Fetuses with Posterior Urethral Valves (PUV). Sci Transl Med 2013; 5:198ra106. [DOI: 10.1126/scitranslmed.3005807] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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8
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Sweetman DU, Molloy EJ. Biomarkers of acute kidney injury in neonatal encephalopathy. Eur J Pediatr 2013; 172:305-16. [PMID: 23138391 DOI: 10.1007/s00431-012-1890-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/24/2012] [Indexed: 01/11/2023]
Abstract
Acute kidney injury (AKI) is a common complication of neonatal encephalopathy (NE). The accurate diagnosis of neonatal AKI, irrespective of the cause, relies on suboptimal methods such as identification of rising serum creatinine, decreased urinary output and glomerular filtration rate. Studies of AKI biomarkers in adults and children have shown that biomarkers can improve the early diagnosis of AKI. Hypoxia-ischaemia is the proposed aetiological basis of AKI in both NE and cardiopulmonary bypass (CPB). However, there is a paucity of studies examining the role of AKI biomarkers specifically in NE. Urinary cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18, kidney injury molecule-1, liver-type fatty acid-binding protein, serum CysC and serum NGAL all show good ability to predict early AKI in a heterogeneous critically ill neonatal population including infants post-CPB. Moreover, serum and urinary NGAL and urinary CysC are early predictors of AKI secondary to NE. These findings are promising and open up the possibility of biomarkers playing a significant role in the early diagnosis and treatment of NE-related AKI. There is an urgent need to explore the role of AKI biomarkers in infants with NE as establishing the diagnosis of AKI earlier may allow more timely intervention with potential for improving long-term outcome.
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Affiliation(s)
- D U Sweetman
- Department of Neonatology, National Maternity Hospital, Holles Street, Dublin, Ireland.
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Ryckewaert-D'Halluin A, Le Bouar G, Odent S, Milon J, D'Hervé D, Lucas J, Rouget F, Loget P, Poulain P, Le Gall E, Taque S. Diagnosis of fetal urinary tract malformations: prenatal management and postnatal outcome. Prenat Diagn 2011; 31:1013-20. [DOI: 10.1002/pd.2824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 06/06/2011] [Accepted: 06/06/2011] [Indexed: 11/07/2022]
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Beta-Trace Protein as a Marker of Renal Dysfunction in Patients with Chronic Kidney Disease: Comparison with Other Renal Markers. J Med Biochem 2010. [DOI: 10.2478/v10011-010-0008-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Beta-Trace Protein as a Marker of Renal Dysfunction in Patients with Chronic Kidney Disease: Comparison with Other Renal MarkersBeta-trace protein (BTP), also known as prostaglandin D synthase, is a low-molecular-mass protein which belongs to the lipocalin protein family. It was found to be increased in the serum of patients with renal diseases. The aim of this study was to compare the clinical usefulness of serum levels of beta-trace protein for the detection of renal dysfunction in patients with chronic kidney disease (CKD) with levels of other renal markers: creatinine, cystatin C and β2-microglobulin (B2M). The study included 134 patients with a wide range of renal dysfunction that encompassed all five CKD stages. Obtained data showed that beta-trace protein highly correlated (Spearman test) with creatinine (r = 0.890), cystatin C (r = 0.904) and B2M (r = 0.933) and its levels in serum significantly increased from CKD stage 1 to 5. Furthermore, the values of glomerular filtration rate (GFR) estimated from a BTP-based formula significantly correlated with GFR calculated from creatinine-based and cystatin C-based formulas. ROC analyses showed that BTP had similar diagnostic accuracy for detection of reduced renal function in CKD stages as other renal markers, for estimated GFRs of < 30, < 60 and < 90 mL/min/1.73 m2. The areas under the ROC curves (AUC) for BTP, for these GFR limits, were from 0.983 to 0.917 and they were not significantly different from AUCs for other renal markers. The results of this study showed that BTP may be a useful and reliable serum marker for identifying the magnitude of renal dysfunction in patients with CKD and may have its place beside serum cystatin C and creatinine as an alternative endogenous GFR marker.
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Nielsen EI, Sandström M, Honoré PH, Ewald U, Friberg LE. Developmental pharmacokinetics of gentamicin in preterm and term neonates: population modelling of a prospective study. Clin Pharmacokinet 2009; 48:253-63. [PMID: 19492870 DOI: 10.2165/00003088-200948040-00003] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Preterm and term newborn infants show wide interindividual variability (IIV) in pharmacokinetic parameters of gentamicin. More extensive knowledge and use of predictive covariates could lead to faster attainment of therapeutic concentrations and a reduced need for concentration monitoring. This study was performed to characterize the population pharmacokinetics of gentamicin in preterm and term neonates and to identify and quantify relationships between patient characteristics and IIV. A secondary aim was to evaluate cystatin C as a marker for gentamicin clearance in this patient population. METHODS Data were collected in a prospective study performed in the Neonatal Intensive Care Unit at the University Children's Hospital, Uppsala, Sweden. Population pharmacokinetic modelling was performed using nonlinear mixed-effects modelling (NONMEM) software. Bodyweight was included as the primary covariate according to an allometric power model. Other evaluated covariates were age (postmenstrual age, gestational age [GA], postnatal age [PNA]), markers for renal function (serum creatinine, serum cystatin C) and concomitant medication with cefuroxime, vancomycin or indometacin. Covariate-parameter relationships were explored using a stepwise covariate model building procedure. The predictive performance of the developed model was evaluated using an independent external dataset for a similar patient population. RESULTS Sixty-one newborn infants (GA range 23.3-42.1 weeks, PNA range 0-45 days) were enrolled in the study. In total, 894 serum gentamicin samples were included in the analysis. The concentration-time profile was described using a three-compartment model. Gentamicin clearance increased with the GA and PNA (included in a nonlinear fashion). The GA was also identified as having a significant influence on the central volume of distribution, with a preterm neonate having a larger central volume of distribution per kilogram of bodyweight than a term neonate. Cystatin C and creatinine were not correlated with gentamicin clearance in this study population. The external dataset was well predicted by the developed model. CONCLUSION Bodyweight and age (GA and PNA) were found to be major factors contributing to IIV in gentamicin clearance in neonates. Based on these data, cystatin C and serum creatinine were not correlated with gentamicin clearance and therefore not likely to be predictive markers of renal function in this patient population. Based on predictions from the developed model, preterm neonates do not reach targeted peak and trough gentamicin concentrations after a standard dosage regimen of 4 mg/kg given once daily, suggesting a need for higher loading doses and prolonged dosing intervals in this patient population.
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Affiliation(s)
- Elisabet I Nielsen
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
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Kristensen K, Strevens H, Lindström V, Grubb A, Wide‐Swensson D. Increased plasma levels of ß2‐microglobulin, cystatin C and ß‐trace protein in term pregnancy are not due to utero‐placental production. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 68:649-53. [DOI: 10.1080/00365510802007804] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Abstract
Congenital urinary tract obstruction is a heterogenous condition with a varying natural history. Accurate diagnosis within the late-first and second trimesters allows for counselling of the parents and planning of multi-disciplinary care for the pregnancy and newborn. Antenatal investigations to predict postnatal renal function are of varying accuracy. However, some factors have been shown to be predictive of poor outcome in terms of renal function at birth and infancy. There is the possibility of in-utero intervention in these fetuses.
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Affiliation(s)
- R K Morris
- Academic Department of Obstetrics and Gynaecology, Birmingham Women's Hospital, University of Birmingham, Birmingham B15 2TG, UK.
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Dreux S, Rousseau T, Gerber S, Col JY, Dommergues M, Muller F. Fetal serum β2-microglobulin as a marker for fetal infectious diseases. Prenat Diagn 2006; 26:471-4. [PMID: 16652403 DOI: 10.1002/pd.1441] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate whether fetal serum beta2-microglobulin could be used as a marker of fetal cytomegalovirus (CMV) or toxoplasmosis infection. METHODS beta2-microglobulin was retrospectively assayed in fetal serum collected from 64 patients with maternal infectious seroconversion (toxoplasmosis in 49 cases, CMV in 15). Using a beta2-microglobulin cutoff of 5 mg/L, infection and control groups were compared. RESULTS Fetal serum beta2-microglobulin was >5 mg/L (5.2-13.5 mg/L) in 12 of the 13 cases with proved fetal toxoplasmosis infection, indicating 90% sensitivity. In the 39 pregnancies with maternal seroconversion but no laboratory signs of fetal infection, fetal serum beta2-microglobulin was <5 mg/L, indicating 100% specificity. Fetal serum was >5 mg/L (6.3-32 mg/L) in 14 of the 15 cases with proved fetal CMV infection, indicating 93.3% sensitivity. Specificity cannot be evaluated because maternal serum is not routinely screened for CMV during pregnancy. CONCLUSIONS Fetal serum beta2-microglobulin is a reliable marker of fetal CMV or toxoplasmosis infection, which can be used in ambiguous situations. Because this increase is not specific, fetal serum beta2-microglobulin would potentially be raised in other fetal infections.
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Affiliation(s)
- Sophie Dreux
- Biochimie-Hormonologie, Hôpital Robert Debré, AP-HP, 48 boulevard Sérurier, 75935 Paris cedex 19, France
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Abstract
Some anomalies of the kidney and urinary tract evolving in utero may compromise the renal function in the newborn. Early therapeutic options do exist, especially in obstructive nephropathies. The decision depends on a correct evaluation of the foetal enal function and prognosis, which is based on a range of methods: ultrasound echography, biochemical analysis of foetal urine, and, more recently, foetal serum markers such a beta-2 micro globulin. These methods are reviewed.
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Affiliation(s)
- Y Dumez
- Service de médecine foetale, Hôpital Necker, 149, rue de Sèvres, 75015 Paris, France.
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Filler G, Browne R, Seikaly MG. Glomerular filtration rate as a putative 'surrogate end-point' for renal transplant clinical trials in children. Pediatr Transplant 2003; 7:18-24. [PMID: 12581323 DOI: 10.1034/j.1399-3046.2003.00015.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Only with prospective randomized controlled trials is it possible to evaluate the several immunosuppressive regimens available to renal allograft recipients. Commonly used surrogate markers of clinical outcome, such as patient and graft survival, are constantly improving. Current immunosuppressive protocols have improved 1-yr graft survival to over 90%. The small differences in graft survival among the various immunosuppressive regimes require large patient cohorts in order to establish statistical significance. Such studies are often difficult to conduct in a timely manner, particularly in children. This necessitates the search for better surrogate markers sensitive enough to detect differences in smaller cohorts and in a shorter period of time. While the degree of fibrosis in transplant biopsies might well predict long-term graft survival, protocol biopsies are expensive, invasive, and unpopular among clinicians. In native kidneys, glomerular filtration rate (GFR) closely correlates with disease progression and interstitial fibrosis and appears to be well positioned as a less invasive surrogate marker for long-term outcome. Nonetheless, the ideal marker for GFR remains obscure. Serum creatinine has several major drawbacks, making it a poor predictor of GFR. This review discusses the several methods used to estimate or measure GFR with emphasis on 125I-iothalamate clearance and serum cystatin C (cys-C). Of all the serum markers, cys-C is the most reliable and the most promising. However, cys-C and other endogenous markers cannot replace the diagnostic sensitivity and reliability of radiolabeled markers of GFR such as 125I-iothalamate in renal transplant clinical trials. Unfortunately, clearance of most radiolabeled markers of GFR including 125I-iothalamate remain costly and time consuming.
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Affiliation(s)
- Guido Filler
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
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Filler G, Priem F, Lepage N, Sinha P, Vollmer I, Clark H, Keely E, Matzinger M, Akbari A, Althaus H, Jung K. β-Trace Protein, Cystatin C, β2-Microglobulin, and Creatinine Compared for Detecting Impaired Glomerular Filtration Rates in Children. Clin Chem 2002. [DOI: 10.1093/clinchem/48.5.729] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AbstractBackground: Because of the limitations of serum creatinine as a marker of glomerular filtration rate (GFR) in children, we assessed the diagnostic accuracy of the novel marker β-trace protein (BTP) in comparison with cystatin C (Cys-C), β2-microglobulin (β2-MG), and creatinine as conventional indicators of reduced GFR.Methods: We obtained serum samples from 225 children (age range, 0.2–18 years) with various renal pathologies who were referred for nuclear medicine clearance investigations (technetium-diethylenetriamine pentaacetic acid or chromium-EDTA). We measured Cys-C, BTP (nephelometric tests; Dade Behring), β2-MG (Tinaquant; Roche), and creatinine (enzymatic assay; Creatinine-PAP; Roche).Results: Seventy-five children had reduced GFR (<90 mL · min−1 · 1.73 m−2). One hundred fifty children (independent of gender and age) with values >90 mL · min−1 · 1.73 m−2 comprised the control group with gaussian distributions of BTP and Cys-C concentrations. The upper reference limits (97.5 percentile) were 1.01 mg/L for BTP and 1.20 mg/L for Cys-C. The correlations of nuclear medicine clearance with the reciprocals of BTP, Cys-C, and the Schwartz GFR estimate were significantly higher (r = 0.653, 0.765, and 0.706, respectively; P <0.05) than with the reciprocal of creatinine or β2-MG (r = 0.500 and 0.557, respectively). ROC analysis showed a significantly higher diagnostic accuracy of BTP, Cys-C, and the GFR estimate for the detection of impaired GFR than serum creatinine (P <0.05). Compared to creatinine, BTP increased the diagnostic sensitivity by ∼30%, but it was not more sensitive than Cys-C or the Schwartz GFR estimate.Conclusions: BTP is superior to serum creatinine and an alternative for Cys-C to detect mildly reduced GFR in children, but it is not better than the Schwartz GFR estimate.
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Affiliation(s)
- Guido Filler
- Departments of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1 Canada
| | - Friedrich Priem
- Departments of Laboratory Medicine, University Hospital Charité, Humboldt University, D-10117 Berlin, Germany
| | - Nathalie Lepage
- Departments of Biochemistry, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1 Canada
| | - Pranav Sinha
- Departments of Laboratory Medicine, University Hospital Charité, Humboldt University, D-10117 Berlin, Germany
| | - Ilka Vollmer
- Departments of Pediatric Nephrology, University Hospital Charité, Humboldt University, D-10117 Berlin, Germany
| | - Heather Clark
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1N 6N5 Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1N 6N5 Canada
| | - Mary Matzinger
- Departments of Radiology, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1 Canada
| | - Ayub Akbari
- Department of Medicine, University of Ottawa, Ottawa, Ontario, K1N 6N5 Canada
| | | | - Klaus Jung
- Departments of Urology, University Hospital Charité, Humboldt University, D-10117 Berlin, Germany
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18
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Nicolini U, Spelzini F. Invasive assessment of fetal renal abnormalities: urinalysis, fetal blood sampling and biopsy. Prenat Diagn 2001; 21:964-9. [PMID: 11746150 DOI: 10.1002/pd.212] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are a number of potential biochemical markers that may have some role in predicting renal function postnatally. These include urinary sodium, calcium and beta2-microglobulin. The latter may also be measured in fetal serum. However, the accuracy of these parameters at a point in time is far from perfect as urinary tract obstruction is a progressive disease which may be best defined by repeated observations throughout pregnancy.
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Affiliation(s)
- U Nicolini
- Department of Obstetrics and Gynaecology, Ospedale V. Buzzi, University of Milan, Via Castelvetro 32, 20147 Milan, Italy
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19
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Bökenkamp A, Dieterich C, Dressler F, Mühlhaus K, Gembruch U, Bald R, Kirschstein M. Fetal serum concentrations of cystatin C and beta2-microglobulin as predictors of postnatal kidney function. Am J Obstet Gynecol 2001; 185:468-75. [PMID: 11518911 DOI: 10.1067/mob.2001.115283] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Cystatin C and beta(2)-microglobulin are established serum markers of renal function in children and adults. In contrast to creatinine, diaplacental exchange is minimal. The aim of the study was to establish reference values in fetal serum and to test their efficiency in predicting postnatal kidney function. STUDY DESIGN This was a prospective noninterventional study measuring cystatin C and beta(2)-microglobulin by particle-enhanced immunoturbidimetry in excess serum from 129 cordocenteses performed in 84 fetuses. Reference intervals (mean +/- 1.96 SD) were calculated in a subgroup of 54 fetuses without evidence of kidney disease, and these reference values were evaluated in 75 sera from 55 fetuses. RESULTS Mean cystatin C was 1.66 +/- 0.202 mg/L (upper limit 2.06), and mean beta(2)-microglobulin was 4.25 +/- 0.734 mg/L. Unlike cystatin C, beta(2)-microglobulin decreased significantly with gestational age so that the upper reference limit was 7.19-0.052 x gestational age in weeks. beta(2)-Microglobulin had higher sensitivity (90.0% vs 63.6%) and cystatin C a higher specificity (91.8% vs. 85.5%) for the prediction of impaired renal function; diagnostic efficiency was equal (87.6% vs. 86.1%). Fetuses with impaired renal function at birth or who were aborted for renal malformations had higher cystatin C concentrations than those in a control group. beta(2)-Microglobulin was increased only in fetuses who were aborted. CONCLUSION Fetal serum cystatin C and beta(2)-microglobulin concentrations may be useful predictors of postnatal kidney function.
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Affiliation(s)
- A Bökenkamp
- Bonn University Children's Hospital, Bonn, Germany
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20
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Ciardelli V, Rizzo N, Farina A, Vitarelli M, Boni P, Bovicelli L. Prenatal evaluation of fetal renal function based on serum beta(2)-microglobulin assessment. Prenat Diagn 2001; 21:586-8. [PMID: 11494297 DOI: 10.1002/pd.90] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The relationship between fetal renal function (FRF) and fetal serum beta(2)-microglobulin (B2MG) was investigated by comparing its value in 112 unaffected fetuses with that of 23 fetuses presenting with urinary tract malformations (UTM). Fetal serum level of B2MG was totally unrelated to gestational age; its value increased in cases of severe impairment of FRF but was similar to controls in all mild uropathies (p<0.05). Evaluating serum B2MG could be beneficial in fetuses with severe renal damage, but is of no use in unilateral UTM since only the global FRF is tested and not the function of each single kidney.
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Affiliation(s)
- V Ciardelli
- Clinica Ostetrica e Ginecologica e Medicina dell'Eta' Prenatale Ospedale S. Orsola, Università degli Studi di Bologna, Bologna, Italy.
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21
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Dommergues M, Muller F, Ngo S, Hohlfeld P, Oury JF, Bidat L, Mahieu-Caputo D, Sagot P, Body G, Favre R, Dumez Y. Fetal serum beta2-microglobulin predicts postnatal renal function in bilateral uropathies. Kidney Int 2000; 58:312-6. [PMID: 10886576 DOI: 10.1046/j.1523-1755.2000.00167.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Predicting postnatal renal function is crucial for the prenatal evaluation of fetal bilateral uropathies. Prenatal ultrasound can identify intrauterine terminal renal failure, but is not sensitive enough to identify those infants who would survive with an impaired renal function. Because it reflects fetal glomerular filtration, fetal serum beta2-microglobulin is a potential predictor of postnatal renal function. METHODS Fetal serum beta2-microglobulin (beta2m) was assayed in 61 cases of bilateral or low obstructive uropathy, 74 controls, and 17 cases of bilateral renal agenesis, and was correlated with renal function. RESULTS Fetal serum beta2m was 3.2 mg/L (range 1.5 to 4.7) in controls (N = 74), 9.5 mg/L (range 6.7 to 11.3) in bilateral renal agenesis (N = 17), 7 mg/L (5.1 to 10.6) in uropathy in which terminal renal failure resulted in termination of pregnancy (N = 26), and 3.7 mg/L (range 2.3 to 11.2) in live births with uropathy (N = 35). In the latter subgroup, fetal serum beta2m was significantly and positively correlated (r2 = 0.91) with postnatal serum creatinine. All survivors with a postnatal serum creatinine < or =50 micromol/L ha a fetal serum beta2m lower than 5 mg/L. Four of 6 survivors with a postnatal serum creatinine> 50 micromol/L had a fetal serum beta2m greater than 5 mg/L. CONCLUSION Fetal serum beta2-microglobulin is a marker for renal function and predicts postnatal serum creatinine in bilateral or low fetal obstructive uropathy.
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Affiliation(s)
- M Dommergues
- Maternité, Hôpital A. Béclère, and Biochimie, Hôpital A. Paré Paris, France
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22
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Cağdaş A, Aydinli K, Irez T, Temizyürek K, Apak MY. Evaluation of the fetal kidney maturation by assessment of amniotic fluid alpha-1 microglobulin levels. Eur J Obstet Gynecol Reprod Biol 2000; 90:55-61. [PMID: 10767511 DOI: 10.1016/s0301-2115(99)00203-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the fetal renal maturation by assessment of amniotic fluid microproteins and to show these proteins originate from fetal urine. STUDY DESIGN Amniotic fluid proteins (total protein, albumin, high molecular weight protein-HMWP, low molecular weight protein-LMWP, alpha(1)-microglobulin and beta(2)-microglobulin) were determined in 39 pregnant women at delivery and by amniocentesis in 30 pregnant women. These values were compared with first urine values of neonates with the same gestational age. RESULTS Albumin was the largest protein component in the amniotic fluid. LMWP showed an increase in the amniotic fluid until the end of the second trimester; and as pregnancy advanced a progressive decrease occurred in parallel to fetal renal maturation. After 26 weeks' gestation, a strong correlation was identified between LMWP levels and alpha(1)-microglobulin, and between LMWP and beta(2)-microglobulin. No significant difference was detected between LMWP levels in the first urine of the neonates and in amniotic fluids. CONCLUSION Microproteins in the fetal urine are of fetal origin. Fetal renal maturation can be evaluated by measuring microproteins in the amniotic fluid. Fetal renal maturation is best reflected by alpha(1)-microglobulin.
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Affiliation(s)
- A Cağdaş
- Department of Obstetrics and Gynecology, Cerrahpasa Medical Faculty, Istanbul, Turkey
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23
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Muller F, Bernard MA, Benkirane A, Ngo S, Lortat-Jacob S, Oury JF, Dommergues M. Fetal Urine Cystatin C as a Predictor of Postnatal Renal Function in Bilateral Uropathies. Clin Chem 1999. [DOI: 10.1093/clinchem/45.12.2292] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | - Sandrine Ngo
- Biochimie, Hôpital Ambroise Paré, 92104 Boulogne, France
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24
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Haycock GB. Development of glomerular filtration and tubular sodium reabsorption in the human fetus and newborn. BRITISH JOURNAL OF UROLOGY 1998; 81 Suppl 2:33-8. [PMID: 9602793 DOI: 10.1046/j.1464-410x.1998.0810s2033.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- G B Haycock
- Division of Paediatrics, Guy's Medical and Dental School, Guy's Hospital, London, UK
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25
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Filler G, Witt I, Priem F, Ehrich JHH, Jung K. Are Cystatin C and β2-Microglobulin Better Markers than Serum Creatinine for Prediction of a Normal Glomerular Filtration Rate in Pediatric Subjects? Clin Chem 1997. [DOI: 10.1093/clinchem/43.6.1077] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Guido Filler
- Dept. of Paediatr. Nephrol., Charité Hosp., Humboldt Univ., Schumannstr. 20–21, D-10098 Berlin, Germany
| | - Iris Witt
- Dept. of Paediatr. Nephrol., Charité Hosp., Humboldt Univ., Schumannstr. 20–21, D-10098 Berlin, Germany
| | - Friedrich Priem
- Dept. of Clin. Biochem., Charité Hosp., Humboldt Univ., Schumannstr. 20–21, D-10098 Berlin, Germany
| | - Jochen H H Ehrich
- Dept. of Paediatr. Nephrol., Charité Hosp., Humboldt Univ., Schumannstr. 20–21, D-10098 Berlin, Germany
| | - Klaus Jung
- Dept. of Urol., Charité Hosp., Humboldt Univ., Schumannstr. 20–21, D-10098 Berlin, Germany
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26
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Tassis BM, Trespidi L, Tirelli AS, Pace E, Boschetto C, Nicolini U. Serum beta 2-microglobulin in fetuses with urinary tract anomalies. Am J Obstet Gynecol 1997; 176:54-7. [PMID: 9024089 DOI: 10.1016/s0002-9378(97)80011-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Our purpose was to establish a reference range of fetal serum beta 2-microglobulin, an index of glomerular filtration rate, and to compare the values obtained in fetuses with urinary tract anomalies with this range. STUDY DESIGN Serum beta 2-microglobulin was measured in 53 control fetuses at 18 to 39 weeks' gestation and in 14 fetuses with urinary tract anomalies, 9 of which had simultaneous urine sampling. RESULTS In controls fetal serum beta 2-microglobulin had a mean value of 3.4 mg/L (95% data intervals 2.0 to 4.9) and did not correlate with gestational age. In the 14 fetuses with urinary tract anomalies beta 2-microglobulin levels were increased overall compared with controls (median Z score 1.7, range -0.1 to 9.2), and this was also the case in the five fetuses with unilateral renal disorders (median Z score 1.7, range -0.1 to 3.8) and in a fetus who underwent vesicoamniotic shunting and had normal renal function at birth. Serum beta 2-microglobulin was normal in 4 fetuses with bilateral urinary tract obstruction and normal function at postnatal follow-up and also in 1 of 5 fetuses with renal failure. In fetuses with bilateral uropathy urinary sodium correlated with serum beta 2-microglobulin levels. CONCLUSIONS Increased values of serum beta 2-microglobulin in fetuses with urinary tract anomalies indicate an impaired glomerular filtration rate. The finding of raised concentrations in fetuses with unilateral damage suggests that the compensatory role of the normal kidney is not complete during intrauterine life. Larger series are required to ascertain whether fetal blood sampling is warranted in the antenatal investigation of renal function, especially in view of the close correlation between urinary sodium and serum beta 2-microglobulin levels in fetuses with bilateral obstruction.
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Affiliation(s)
- B M Tassis
- First Department of Obstetrics and Gynecology, University of Milano, Italy
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27
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Ratjen F, Kreuzfelder E. Immunoglobulin and beta 2-microglobulin concentrations in bronchoalveolar lavage of children and adults. Lung 1996; 174:383-91. [PMID: 8887933 DOI: 10.1007/bf00164635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Immunoglobulins play an important role in the pulmonary host defense, but little information is available about immunoglobulin and beta 2-microglobulin concentrations in the lung of normal children. Using bronchoalveolar lavage (BAL) we have studied immunoglobulin and beta 2-microglobulin levels in 30 children 3-15 years old undergoing elective surgery for nonpulmonary illnesses and in 15 healthy adult volunteers. BAL was performed with 3 x 1 ml/kg of body weight normal saline through an endotracheal tube after induction of anesthesia in children and under local anesthesia in adults. Similar concentrations of IgA and IgG were found in BAL fluid of children and adults even though serum levels were lower in children. As comparable results were obtained for albumin, a serum-derived protein, these data suggest that the permeability of the alveolar membrane is higher in children. IgE and IgM were detected in BAL fluid in only a fraction of children. beta 2-microglobulin levels were higher in both blood and BAL fluid of children. These data provide the first reference data for immunoglobulin and beta 2-microglobulin in children and can serve as a basis for future studies of children with pulmonary diseases.
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Affiliation(s)
- F Ratjen
- Department of Pediatrics, University Hospital of Essen, Germany
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28
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Cobet G, Gummelt T, Bollmann R, Tennstedt C, Brux B. Assessment of serum levels of alpha-1-microglobulin, beta-2-microglobulin, and retinol binding protein in the fetal blood. A method for prenatal evaluation of renal function. Prenat Diagn 1996; 16:299-305. [PMID: 8734802 DOI: 10.1002/(sici)1097-0223(199604)16:4<299::aid-pd844>3.0.co;2-n] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The concentrations of alpha-1-microglobulin, beta-2-microglobulin, and retinol binding protein were determined in fetal blood sampled by cordocentesis. The blood values of 126 fetuses without ultrasonographic findings of urinary tract abnormalities as controls were found to be independent of the week of gestation. In nine fetuses affected by a severe bilateral renal dysplasia or agenesis, elevated values of alpha-1-microglobulin but normal values of retinol binding protein were obtained. The authors recommend the determination of alpha-1-microglobulin and, with some restriction, also of beta-2-microglobulin in prenatal renal function diagnosis.
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Affiliation(s)
- G Cobet
- Institute of Medical Genetics, Medical School (Charite), Humboldt University, Berlin, Germany
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29
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Mussap M, Fanos V, Piccoli A, Zaninotto M, Padovani EM, Plebani M. Low molecular mass proteins and urinary enzymes in amniotic fluid of healthy pregnant women at progressive stages of gestation. Clin Biochem 1996; 29:51-6. [PMID: 8929824 DOI: 10.1016/0009-9120(95)02006-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Amniotic fluid alpha1-microglobulin (alpha1-m) and beta2-microglobulin (beta2-m) levels, as well as N-acetyl-beta-D-glucosaminidase (NAG) and alanine aminopeptidase (AAP) activities, were measured in the course of uncomplicated pregnancies to assess their variations as gestation progresses. DESIGN AND METHODS Samples were obtained from 141 healthy pregnant women divided into three groups on the basis of gestational stage. Quantitative estimation of proteins was performed immunometrically and enzyme activities were determined spectrophotometrically. RESULTS It was found that, during pregnancy, alpha1-m and beta2-m concentrations as well as AAP activity significantly decrease, although their reduction patterns vary. Controversial results were found for NAG activity: the normalization of values for amniotic fluid creatinine significantly changed the reduction pattern of this enzyme. No statistically significant differences were found between male and female fetuses for amniotic fluid values of the biochemical substances studied. CONCLUSIONS The behavior observed for alpha1-m, beta2-m, and AAP might be linked to the progressive development and maturation of fetal renal tubular function. Amniotic fluid total NAG activity seems not to depend only on fetal urinary excretion.
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Affiliation(s)
- M Mussap
- Department of Laboratory Medicine, School of Medicine, University of Padova, Italy
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30
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Berry SM, Lecolier B, Smith RS, Bercau G, Dombrowski MP, Puder KS, Kithier K, Bidat L, Johnson MP, Cotton DB. Predictive value of fetal serum beta 2-microglobulin for neonatal renal function. Lancet 1995; 345:1277-8. [PMID: 7746060 DOI: 10.1016/s0140-6736(95)90928-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
When fetal urinary-tract malformations (UTM) are discovered, management is based on the prediction of postnatal renal function, currently made by fetal urinary biochemistry and sonography. Serum beta 2-microglobulin has been used postnatally to estimate renal function and does not cross the placenta. We investigated the relation between fetal serum beta 2-microglobulin and renal function by comparing 64 unaffected fetuses and 15 fetuses with UTM. A beta 2-microglobulin above a 5.6 mg/L cut-off gave cross-validated sensitivity of 80.0%, specificity of 98.6%, a positive predictive value of 88.9%, and a negative predictive value of 97.1% for our cohort study.
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Affiliation(s)
- S M Berry
- Division of Maternal Fetal Medicine, Wayne State University, Detroit, Michigan, USA
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31
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Padovani EM, Fanos V, Mussap M, Plebani M, Burlina A. Tubular proteins and enzyme content in the amniotic fluid. Eur J Obstet Gynecol Reprod Biol 1994; 55:129-33. [PMID: 7525367 DOI: 10.1016/0028-2243(94)90067-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Amniotic fluid is the product of many substances and fetal urine is considered to be one of the principal components. Only a few reports have been published describing the concentration of microglobulins and urinary enzymes in the amniotic fluid. We determined the levels of alpha 1-m, beta 2-m, AAP and NAG, in 154 samples of amniotic fluid (103 early determinations and 51 late determinations) as a function of gestational age. We observed a statistically significant decrease in concentration of alpha 1-m (P < 0.001), beta 2-m (P < 0.01) and AAP (P < 0.001) when early and late amniotic fluid samples were compared. A statistically significant increase of NAG (P < 0.01) and creatinine (P < 0.01) was also found. A significant correlation was observed between alpha 1-m and beta 2-m, and between AAP and NAG, respectively. The potential role of urinary enzyme and microglobulin determination in amniotic fluid as an index of fetal kidney development, is discussed.
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Affiliation(s)
- E M Padovani
- Clinica Pediatrica, Università di Verona, Ospedale Policlinico Borgo, Roma, Italy
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32
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Hurley RM. Assessment of Renal Function in the Young: Special Considerations. Clin Lab Med 1993. [DOI: 10.1016/s0272-2712(18)30473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Low molecular weight proteins are of interest in children because their increased urinary excretion is a sign of renal tubular disease and their increased plasma concentration is inversely related to glomerular filtration rate. These proteins include beta 2-microglobulin (B2M), retinol-binding protein (RBP), alpha 1-microglobulin (A1M) and lysozyme. B2M is unstable in acid urine, in contrast to RBP and A1M which are more stable. Any increase in the urinary excretion of B2M or RBP is highly specific for tubular disease, whereas increased excretion of A1M may be seen with glomerular proteinuria. Areas of clinical application include tubular and glomerular diseases, detection of drug toxicity, reflux nephropathy, birth asphyxia and insulin-dependent diabetes mellitus. Methods of sample collection and analysis of these proteins are discussed.
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