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Okamoto S, Matsuyama T, Hamada R, Morikawa Y, Tomotsune M, Kaneko T, Abe K, Uchiyama A, Honda M. Reference values for urinary protein, albumin, beta 2-microglobulin, and the alpha 1-microglobulin-to-creatinine ratio in Japanese children. Clin Exp Nephrol 2024; 28:50-57. [PMID: 37676464 PMCID: PMC10766671 DOI: 10.1007/s10157-023-02392-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 08/10/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The importance of the ratio of creatinine to urinary protein, albumin, and low-molecular weight protein as a urinary marker in chronic kidney disease patients is widely recognized. However, no reference values have hitherto been established for these markers in Japanese children. The present study aimed to establish the reference values for these urinary markers in Japanese children. METHODS The first morning urine was randomly collected from 1712 pupils aged ≥ 3 to < 18 years during school and kindergarten mass urinary screenings. The upper limit of the reference values was set at the 97.5th percentile of the creatinine ratio per marker. RESULTS The urinary protein-to-creatinine ratio (PCR), urinary albumin-to-creatinine ratio (ACR), urinary beta 2-microglobulin-to-creatinine ratio (BMCR), and urinary alpha 1-microglobulin-to-creatinine ratio (AMCR) showed an age-related decrease at the 50th percentile reflecting an age-related increase in urinary creatinine. The appropriate reference value for the PCR and ACR was 0.12 g/gCr and 35 mg/gCr, respectively, in the entire cohort. The appropriate reference value for the BMCR was 0.5 μg /mgCr for age ≥ 3 to < 6 years and 0.35 μg/mgCr for age 6 years or older. The appropriate reference value for the AMCR was 5.0 μg/mgCr for age ≥ 3 to < 6 years and 3.5 μg /mgCr for age 6 years or older. CONCLUSION The present study was the first to determine appropriate reference values for the PCR, ACR, BMCR, and AMCR based on an analysis of the first morning urine samples of a large number of children.
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Affiliation(s)
- Shojiro Okamoto
- Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan
| | - Takeshi Matsuyama
- Department of Pediatrics, Fussa Hospital, 1-6-1 Kamidaira, Fussa, Tokyo, Japan
| | - Riku Hamada
- Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, Japan
| | - Yoshihiko Morikawa
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, Japan
| | - Masako Tomotsune
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, Japan
| | - Tetsuji Kaneko
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, Japan
| | - Katsumi Abe
- Tokyo Health Service Association, 1-2 Ichigayasadohara, Shinjuku-Ku, Tokyo, Japan
| | - Atsushi Uchiyama
- Department of Pediatrics, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, Japan
| | - Masataka Honda
- Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, Japan.
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, Japan.
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Nishimura T, Uemura O, Hibino S, Tanaka K, Iwata N, Yamamoto M, Matsukuma E, Miyake Y, Gotoh Y, Fujita N. Analysis of the ratio of urinary beta-2-microglobulin to total protein concentration in children with isolated tubulointerstitial disease. Clin Exp Nephrol 2023; 27:701-706. [PMID: 37093437 DOI: 10.1007/s10157-023-02349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/05/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Proteinuria is broadly classified into glomerular and tubular proteinuria. Urinary beta-2-microglobulin (β2-MG) is known as a marker for detecting tubulointerstitial diseases. However, tubulointerstitial damage can also lead to an increase in urinary β2-MG level in some patients with glomerular diseases. This study aimed to determine the ratio of urinary β2-MG to total protein (TP) concentration in patients with both isolated tubulointerstitial and glomerular disease. METHODS This multicenter, retrospective study included children with Dent disease or lupus nephritis in five facilities. Their urinary β2-MG levels were > 1000 µg/L. Urinary β2-MG and TP concentrations were obtained, and the ratio of urinary β2-MG to TP concentration (µg/mg) was calculated. The Mann-Whitney U test was performed to compare this ratio between these children. The optimal cutoff value of the ratio for considering the presence of glomerular disease was obtained from the receiver operating characteristic (ROC) curve. RESULTS We obtained information on 23 children with Dent disease and 14 children with lupus nephritis. The median ratios of urinary β2-MG to TP concentrations in children with Dent disease and lupus nephritis were 84.85 and 1.59, respectively. The ROC curve yielded the optimal cutoff value of this ratio for distinguishing between these diseases, and the cutoff value was found to be 22.3. CONCLUSION In children with tubulointerstitial diseases, the urinary β2-MG concentration may be approximately 8.5% of the TP concentration. The possibility of presenting with glomerular disease should be considered in patients with a ratio of urinary β2-MG to TP concentration of < 22.3 (µg/mg).
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Affiliation(s)
- Tatsuya Nishimura
- Department of Nephrology, Aichi Children's Health and Medical Center, 7-426 Morioka-cho, Obu, Aichi, 474-8710, Japan.
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Osamu Uemura
- Ichinomiya Medical and Habilitation Center, 1679-2 Tomida-nagaresuji, Ichinomiya, Aichi, 494-0018, Japan
| | - Satoshi Hibino
- Department of Nephrology, Aichi Children's Health and Medical Center, 7-426 Morioka-cho, Obu, Aichi, 474-8710, Japan
| | - Kazuki Tanaka
- Department of Nephrology, Aichi Children's Health and Medical Center, 7-426 Morioka-cho, Obu, Aichi, 474-8710, Japan
| | - Naomi Iwata
- Department of Infection and Immunology, Aichi Children's Health and Medical Center, 7-426 Morioka-cho, Obu, Aichi, 474-8710, Japan
| | - Masaki Yamamoto
- Department of Pediatrics, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Eiji Matsukuma
- Department of Pediatric Nephrology, Gifu Prefectural General Medical Center, 4-6-1 Noishiki, Gifu, Gifu, 500-8717, Japan
| | - Yoshishige Miyake
- Department of Pediatrics, Ichinomiya Municipal Hospital, 2-2-22 Bunkyo, Ichinomiya, Aichi, 491-8558, Japan
| | - Yoshimitsu Gotoh
- Department of Pediatric Nephrology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myoken-Cho Showa-ku, Nagoya, Aichi, 466-8650, Japan
| | - Naoya Fujita
- Department of Nephrology, Aichi Children's Health and Medical Center, 7-426 Morioka-cho, Obu, Aichi, 474-8710, Japan
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HAYASHI A, OKAMOTO T, NIO-KOBAYASHI J, IWAHARA N, SUZUKI R, UEDA Y, TAKAHASHI T, Yasuyuki SATO, IWANAGA T, HOTTA K. CD44 as a pathological marker for the early detection of calcineurin inhibitor-induced nephrotoxicity post kidney transplantation. Biomed Res 2022; 43:181-186. [DOI: 10.2220/biomedres.43.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Asako HAYASHI
- Department of Pediatrics, Hokkaido University Graduate School of Medicine
| | - Takayuki OKAMOTO
- Department of Pediatrics, Hokkaido University Graduate School of Medicine
| | - Junko NIO-KOBAYASHI
- Laboratory of Histology and Cytology, Hokkaido University Graduate School of Medicine
| | - Naoya IWAHARA
- Department of Renal Genitourinary Surgery, Hokkaido University Graduate School of Medicine
| | - Ryota SUZUKI
- Department of Pediatrics, Hokkaido University Graduate School of Medicine
| | - Yasuhiro UEDA
- Department of Pediatrics, Hokkaido University Graduate School of Medicine
| | | | - Yasuyuki SATO
- Department of Pediatrics, Hokkaido University Graduate School of Medicine
| | - Toshihiko IWANAGA
- Laboratory of Histology and Cytology, Hokkaido University Graduate School of Medicine
| | - Kiyohiko HOTTA
- Department of Renal Genitourinary Surgery, Hokkaido University Graduate School of Medicine
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Urinary Beta-2-Microglobulin and Late Nephrotoxicity in Childhood Cancer Survivors. J Clin Med 2021; 10:jcm10225279. [PMID: 34830560 PMCID: PMC8622945 DOI: 10.3390/jcm10225279] [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] [Received: 09/09/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 12/02/2022] Open
Abstract
The objectives of this study were to evaluate urinary beta-2-microglobulin (β2M) levels in long-term childhood cancer survivors and to establish its association with anticancer drug-induced nephrotoxicity. The study consisted of 165 childhood cancer survivors (CCS) who were in continuous complete remission. We reported that CCS had a significantly higher level of β2M (p < 0.001) and β2M/Cr. ratio (p < 0.05) than healthy peers. Among all participants, 24 (14.5%) had decreased eGFR (<90 mL/min/1.73 m2). A significant positive correlation between β2M/Cr. ratio and body mass index (coef. 14.48, p = 0.046) was found. Furthermore, higher levels of urinary β2M were detected among CCS with a longer follow-up time (over 5 years) after treatment. Subjects with decreased eGFR showed statistically higher urinary β2M levels (20.06 ± 21.56 ng/mL vs. 8.55 ± 3.65 ng/mL, p = 0.007) compared with the healthy peers. Twelve survivors (7.2%) presented hyperfiltration and they had higher urinary β2M levels than CCS with normal glomerular filtration (46.33 ± 93.11 vs. 8.55 ± 3.65 ng/mL, p = 0.029). This study did not reveal an association between potential treatment-related risk factors such as chemotherapy, surgery, radiotherapy, and the urinary β2M level. The relationship between treatment with abdominal radiotherapy and reduced eGFR was confirmed (p < 0.05). We demonstrated that urinary beta-2-microglobulin may play a role in the subtle kidney injury in childhood cancer survivors; however, the treatment-related factors affecting the β2M level remain unknown. Further prospective studies with a longer follow-up time are needed to confirm the utility of urinary β2M and its role as a non-invasive biomarker of renal dysfunction.
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Hayashi A, Takahashi T, Ueda Y, Sato Y, Okamoto T. Long-term clinical characteristics and renal prognosis of children with tubulointerstitial nephritis and uveitis syndrome. Pediatr Nephrol 2021; 36:2319-2325. [PMID: 33534000 DOI: 10.1007/s00467-021-04956-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/15/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease, especially in children. Owing to the short-term observational period and the small number of patients analyzed in previous reports, the long-term clinical and laboratory characteristics and renal prognosis of children with TINU syndrome remain unclear. METHODS In this retrospective observational study, we enrolled 29 children with TINU syndrome from February 1990 to February 2019. RESULTS During the median follow-up duration of 38 months, the kidney function, urinary β2 microglobulin-creatinine ratio (U-β2MG/Cr), and uveitis in the patients had significantly improved at 24, 6, and 36 months after diagnosis. Higher U-β2MG/Cr was associated with longer duration of kidney function normalization. Half of the patients required uveitis treatment for 5 years after the diagnosis. CONCLUSIONS Patients with severe low-molecular weight proteinuria at diagnosis needed a longer duration to achieve improvements in kidney function. Uveitis has a much longer treatment period than tubulointerstitial nephritis. This study demonstrates the good prognosis of children with TINU syndrome in terms of their long-term clinical and laboratory characteristics.
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Affiliation(s)
- Asako Hayashi
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, 060-8638, Japan.,Department of Pediatrics, Health Sciences University of Hokkaido Hospital, Sapporo, Hokkaido, 002-8072, Japan
| | - Toshiyuki Takahashi
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, 060-8638, Japan
| | - Yasuhiro Ueda
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, 060-8638, Japan
| | - Yasuyuki Sato
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, 060-8638, Japan
| | - Takayuki Okamoto
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, 060-8638, Japan.
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Rypdal V, Jørandli S, Hemmingsen D, Solbu MD, Klingenberg C. Exposure to an Extended-Interval, High-Dose Gentamicin Regimen in the Neonatal Period Is Not Associated With Long-Term Nephrotoxicity. Front Pediatr 2021; 9:779827. [PMID: 34917565 PMCID: PMC8669790 DOI: 10.3389/fped.2021.779827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives: To assess the association between gentamicin exposure and subclinical signs of nephrotoxicity in school children who were exposed to a high-dose gentamicin regimen in the neonatal period. Methods: Children receiving three or more doses (6 mg/kg) of gentamicin as neonates were invited to a follow-up in school age. We evaluated potential signs of subclinical nephrotoxicity with four validated urine biomarkers: protein-creatinine ratio (PCR), albumin-creatinine ratio (ACR), kidney injury molecule-1 (KIM-1), and N-acetyl-beta-D-glucosaminidase (NAG) normalized for urine creatinine (NAG-Cr). In addition, blood pressure was measured. The measures of gentamicin exposure were cumulative dose (mg/kg) and highest trough plasma concentration (TPC) in mg/L. We used logistic and linear regression and non-parametric kernel regression to analyze the relationship between gentamicin exposure and the urine biomarkers. Results: A total of 222 gentamicin exposed children were included. As neonates, the children were exposed to a median (interquartile range-IQR) cumulative gentamicin dose of 36 (26-42) mg/kg and the median (IQR) TPC was 1.0 (0.7-1.3) mg/L. At follow-up, 15 children (6.8%) had either one abnormal urine biomarker value (13 children) or two abnormal urine biomarker values (2 children). These 17 biomarker values were all marginally above the suggested upper cutoff, and included the following markers; KIM-1 (n = 2), NAC-Cr (n = 5), ACR (n = 6), and PCR (n = 4). All other 207 children had normal sets of all four urine biomarkers. One child had hypertension. There were no differences in gentamicin exposure, gestational age (GA) at birth or birth weight between the group of 15 children with one or two abnormal urine biomarker values compared to the other 207 children who had normal biomarker values. Using different regression analyses, we did not find any association between gentamicin exposure (cumulative dose and/or TPC) and the urine biomarker values. Conclusions: Exposure to an extended-interval, high-dose gentamicin regimen in the neonatal period was not associated with signs of subclinical nephrotoxicity in schoolchildren. We therefore suggest that the gentamicin treatment regimen evaluated in this study is safe in terms of long-term nephrotoxicity. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT03253614.
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Affiliation(s)
- Veronika Rypdal
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.,Pediatric Research Group, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Sondre Jørandli
- The Faculty of Health Sciences, Medical School, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Dagny Hemmingsen
- Pediatric Research Group, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway.,Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Marit Dahl Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Claus Klingenberg
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.,Pediatric Research Group, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
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7
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Levin-Schwartz Y, Curtin P, Svensson K, Fernandez NF, Kim-Schulze S, Hair GM, Flores D, Pantic I, Tamayo-Ortiz M, Luisa Pizano-Zárate M, Gennings C, Satlin LM, Baccarelli AA, Tellez-Rojo MM, Wright RO, Sanders AP. Length of gestation and birth weight are associated with indices of combined kidney biomarkers in early childhood. PLoS One 2020; 14:e0227219. [PMID: 31891650 PMCID: PMC6938375 DOI: 10.1371/journal.pone.0227219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/13/2019] [Indexed: 11/19/2022] Open
Abstract
Infants born prematurely or with low birth weights are more susceptible to kidney dysfunction throughout their lives. Multiple proteins measured in urine are noninvasive biomarkers of subclinical kidney damage, but few studies have examined the joint effects of multiple biomarkers. We conducted an exploratory study of 103 children in the Programing Research in Obesity, Growth, Environment, and Social Stressors (PROGRESS) longitudinal birth cohort, and measured nine proteins selected a priori in banked spot urine samples collected at ages 4-6. The goal of our study was to explore the combined effects of kidney damage biomarkers previously associated with birth outcomes. To do this, we generated kidney biomarker indices using weighted quantile sum regression and assessed associations with length of gestation or birth weight. A decile increase in each kidney biomarker index was associated with 2-day shorter gestations (β = -2.0, 95% CI: -3.2, -0.9) and 59-gram lower birth weights (β = -58.5, 95% CI: -98.3, -18.7), respectively. Weights highlighting the contributions showed neutrophil gelatinase-associated lipocalin (NGAL) (60%) and osteopontin (19%) contributed most to the index derived for gestational age. NGAL (66%) and beta-2-microglobulin (10%) contributed most to the index derived for birth weight. Joint analyses of multiple kidney biomarkers can provide integrated measures of kidney dysfunction and improved statistical assessments compared to biomarkers assessed individually. Additionally, shorter gestations and lower birth weights may contribute to subclinical kidney damage measurable in childhood.
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Affiliation(s)
- Yuri Levin-Schwartz
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Paul Curtin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Katherine Svensson
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Nicolas F. Fernandez
- Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Seunghee Kim-Schulze
- Human Immune Monitoring Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Oncological Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Gleicy M. Hair
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Daniel Flores
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Ivan Pantic
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- Department of Developmental Neurobiology, National Institute of Perinatology, Mexico City, Mexico
| | - Marcela Tamayo-Ortiz
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- National Council of Science and Technology, Mexico City, Mexico
| | - María Luisa Pizano-Zárate
- Division of Community Interventions Research, National Institute of Perinatology, Mexico City, Mexico
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Lisa M. Satlin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Andrea A. Baccarelli
- Department of Environmental Health Sciences, Columbia University, New York, NY, United States of America
| | - Martha M. Tellez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Robert O. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Alison P. Sanders
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- * E-mail:
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8
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Tubular dysfunction in extremely low birth weight survivors. Clin Exp Nephrol 2018; 23:395-401. [PMID: 30238383 DOI: 10.1007/s10157-018-1645-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/14/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Extremely low birth weight (ELBW) survivors may develop glomerulosclerosis due to low nephron number, whereas their tubular function remains unknown except for hypercalciuria and phosphaturia. METHODS Fifty-three subjects (30 boys and 23 girls, aged 7 months-19 years, median 36 months) were studied retrospectively. The median gestational age and birth weight were 26 weeks (range 22-32) and 745 g (range 316-999), respectively. Urine calcium-to-creatinine ratio (Ca/Cr), N-acetyl-β-D-glucosaminidase-to-creatinine ratio (NAG/Cr), β2 microglobulin-to-creatinine ratio (β2m/Cr), uric acid-to-creatinine ratio (UA/Cr), glucose-to-creatinine ratio (glu/Cr), and microalbumin-to-creatinine ratio (malb/Cr) were examined. We also assessed the association between urine parameters and current age, gestational age, birth weight, and predictors of renal injury. Follow-up data were analyzed in 43 subjects 4-6 years later. RESULTS Ninety percent of subjects had at least one tubular dysfunction. Frequency of elevated values was NAG/Cr 77.5%, UA/Cr 54.1%, β2m/Cr 38.2%, malb/Cr 30.4%, Ca/Cr 21.5%, and glu/Cr 20.5%. There were significant negative correlations between the current age and Ca/Cr, NAG/Cr, glu/Cr, and UA/Cr, suggesting tubular function maturation. Urine β2M/Cr and glu/Cr were negatively correlated with the gestational age. There were significant associations between elevated glu/Cr and asphyxia or neonatal acute kidney injury, and elevated NAG/Cr and indomethacin use, although these were not confirmed by multivariate analysis. At follow-up, the frequency of elevated NAG/Cr, glu/Cr, UA/Cr, and malb/Cr was reduced but that of elevated Ca/Cr, IgG/Cr, and β2m/Cr remained similar or increased. CONCLUSION Tubular dysfunction is common in ELBW survivors. Some abnormalities resolved with age while some remained persistent or even increased.
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Low Molecular Weight Proteinuria in Children with Distal Renal Tubular Acidosis. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2018; 39:91-95. [PMID: 30110261 DOI: 10.2478/prilozi-2018-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Distal renal tubular acidosis (dRTA) (MIM #267300, #602722 and #179800) is a rare inherited tubulopathy characterized by the inability of the distal tubule to acidify the urine with consecutive systemic acidosis. The clinical features include polyuria, polydipsia, poor appetite, failure to thrive, short stature and rickets. Prominent biochemical features are hypokalemia, hypercalciuria and hypocitraturia. There are reports on patients who presented with unusual biochemical features such as low molecular proteinuria, hypophosphatemia, hypouricemia, generalized hyperaminioaciduria, hyperoxaluria and other making diagnostic confusion to the clinicians. In this work, we report on a series of 8 children with clinically, biochemically and genetically proven dRTA who present with low molecular proteinuria at the disease onset. With metabolic compensation of the disease, there was complete resolution of the low molecular weight protenuria and other proximal tubular abnormalities in all children. Late recognition of the disease with long standing hypokalemia and acidosis may result in abnormal expression and function of the transporters in the proximal tubules. Sodium dodecyl sulphate polyacrylamide gel electrophoeresis is an accurate method for detection and follow up of patients with low molecular weight proteinuria.
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Renal Tubular Complement 3 Deposition in Children with Primary Nephrotic Syndrome. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4386438. [PMID: 30003098 PMCID: PMC5998187 DOI: 10.1155/2018/4386438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 03/29/2018] [Indexed: 11/17/2022]
Abstract
Background This study aimed to investigate the clinical significance of complement 3 (C3) deposition in renal tubules of children with primary nephrotic syndrome (PNS). Methods The clinical and pathological characteristics of PNS were retrospectively reviewed in 99 PNS pediatric patients, who were divided into the C3 deposition and the non-C3 deposition groups. Results A total of 39 patients (39.39%) had renal tubule C3 deposition. In the C3 deposition group, the ratios of urine N-acetylglucosaminidase/creatinine (UNAG/Cr), urine β2 microglobulin/creatinine (Uβ2MG/Cr), and urine transferrin/creatinine (UTRF/Cr) were significantly higher than those of the non-C3 deposition group. The patients of the C3 deposition group had lower serum total protein and albumin, higher cholesterol and D-dimer (DD), lower proportion of CD3+CD8+ cells, and higher proportion of CD19+CD23+ cells. The number of the patients with interstitial fibrosis, renal cell vacuolar degeneration, renal tubular immunoglobulin deposition, and severe tubulointerstitial injury in the C3 deposition group was higher than that of the non-C3 deposition group. The C3 deposition intensity was positively correlated with the number of recurrences. Conclusion PNS pediatric patients with C3 deposition in renal tubules have more severe disease condition, tubulointerstitial injury, and recurrence suggesting a worse long-term prognosis.
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11
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Azuma J, Nabatame S, Katsura T, Yamamoto K, Kaneno H, Kijima E, Mizoguchi Y, Shimotsuji T, Yamamoto T, Ozono K. Marked elevation of urinary β2-microglobulin in patients with reversible splenial lesions: A small case series. J Neurol Sci 2016; 368:109-12. [PMID: 27538611 DOI: 10.1016/j.jns.2016.06.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 06/21/2016] [Accepted: 06/29/2016] [Indexed: 11/24/2022]
Abstract
The magnetic resonance imaging findings of reversible isolated lesions with transiently reduced diffusion in the splenium of corpus callosum of patients with a wide spectrum of pathological conditions are referred to as reversible splenial lesion syndrome (RESLES). Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is probably included within the spectrum of RESLES; however, its exact pathophysiology is not known. Here, we describe three patients with MERS and one patient with RESLES, all of whom showed elevated urinary β2-microglobulin regardless of diagnosis and presence of pathogens. Elevated urinary β2-microglobulin suggested that an excessive immune response might play a role in the pathophysiology of reversible splenial lesions.
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Affiliation(s)
- Junji Azuma
- Department of Pediatrics, Minoh City Hospital, Minoh, Japan.
| | - Shin Nabatame
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Kyoko Yamamoto
- Department of Pediatrics, Minoh City Hospital, Minoh, Japan
| | - Hiroshi Kaneno
- Department of Pediatrics, Minoh City Hospital, Minoh, Japan
| | - Eri Kijima
- Department of Pediatrics, Minoh City Hospital, Minoh, Japan
| | | | | | | | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
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Abstract
The effectiveness of treatment of renal diseases is limited because the lack of diagnostic, prognostic and therapeutic markers. Despite the more than a decade of intensive investigation of urinary biomarkers, no new clinical biomarkers were approved. This is in part because the early expectations toward proteomics in biomarkers discovery were significantly higher than the capability of technology at the time. However, during the last decade, proteomic technology has made dramatic progress in both the hardware and software methods. In this review we are discussing modern quantitative methods of mass-spectrometry and providing several examples of their applications for discovery and validation of renal disease biomarkers. We are optimistic about future prospects for the development of novel of specific clinical urinary biomarkers.
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Affiliation(s)
- Marina Jerebtsova
- Department of Microbiology, Howard University College of Medicine, 520 W Street N.W., Washington, DC 20059, USA
| | - Sergei Nekhai
- Department of Medicine, Howard University College of Medicine, 520 W Street N.W., Washington, DC 20059, USA ; Center for Sickle Cell Disease, Howard University College of Medicine, 520 W Street N.W., Washington, DC 20059, USA
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