Coelution of other proteins with albumin during size-exclusion HPLC: Implications for analysis of urinary albumin

Urine Albumin Measurements in Clinical Diagnostics

BACKGROUND

Measurement of urine albumin is critical for diagnosis, risk classification, and monitoring of chronic kidney disease (CKD). Guidelines recommend clinical decision cutoffs for the urine albumin-to-creatinine ratio (ACR) of 30 and 300 mg/g (3 and 30 mg/mmol). However, differences among manufacturers' routine urine albumin measurement procedures have been found to exceed 40%, suggesting CKD diagnosis and risk classification may vary depending upon the specific measurement procedure implemented in the laboratory.

CONTENT

This review discusses urine albumin pathophysiology and clinical practice guideline recommendations for CKD. The review also provides recommendations for urine specimen collection and storage, and results reporting for the ACR. Recent advances in measurement techniques and development of reference systems intended to facilitate standardization of urine albumin measurements are reviewed.

SUMMARY

Urine albumin is an important measurement procedure used for diagnosis, risk classification, and management of CKD. Urine albumin results should be reported as the ACR using quantitative measurement procedures. Random urine collections used for albuminuria screening should be followed by confirmation with first morning void collections to reduce variation and increase diagnostic accuracy for urine albumin measurement. Most measurement procedures utilize immunoturbidimetric or immunonephelometric techniques. However, results vary significantly among measurement procedures, potentially resulting in differences in classification or risk assessment for CKD. The National Institute for Standards and Technology (NIST) and other laboratories are developing reference systems, including liquid chromatography-tandem mass spectrometry candidate reference measurement procedures and reference materials, to enable standardization of routine measurement procedures.

Pseudomorphic synthesis of bimodal porous silica microspheres for size-exclusion chromatography of small molecules

In this work, mesoporous silica microspheres with bimodal porous structures for size exclusion chromatography (SEC) supports were synthesized via a pseudomorphic transformation method by using 3.5 and 5 μm commercial silica particles as sources and cetyltrimethylammonium bromide (CTAB) as a template. The effects of the synthetic conditions on the pore size distribution were examined, including the temperature, reaction time and the molar ratio of SiO₂:NaOH. Bimodal porous silicas (BPSs) with pore sizes of 3.01 and 12.80 nm were obtained with SiO₂:NaOH:CTAB:H₂O=1:0.1:0.1:20 at 80 °C for 24 h. The BPSs were bonded with diol groups to produce a stationary phase for SEC. The column performance was evaluated with three types of samples, namely, dextran (70 KDa-62 Da), polyethene glycol (PEG) (20 KDa-32 Da) and three biomolecules (36 KDa-1.36 KDa). The column that was packed with a 3.5 μm stationary phase showed excellent resolution for molecular weights of less than 1 KDa with high column efficiency. Carbohydrate samples (dextran (MW=1296), dextran (MW=972), sucrose (MW=342), glucose (MW=180) and glycerol (MW=92)) were separated. Heptaethylene glycol, hexaethylene glycol, pentaethylene glycol, tetraethylene glycol, triethylene glycol, and diethylene glycol were resolved in a PEG200 sample. In summary, this work shows the advantages of bimodal mesopores in SEC for small molecules less than 1 kDa. In the pseudomorphic synthesis, the pore size can be regulated by template micelles. Thus, the development SEC supports with high accuracy for a specified molecular weight range is expected since the pore size can be regulated by the surfactant template.

Determination of Urine Albumin by New Simple High-Performance Liquid Chromatography Method

BACKGROUND

A simple high-performance liquid chromatography (HPLC) method was developed for the determination of albumin in patients' urine samples without coeluting proteins and was compared with the immunoturbidimetric determination of albumin. Urine albumin is important biomarker in diabetic patients, but part of it is immuno-nonreactive.

METHODS

Albumin was determined by high-performance liquid chromatography (HPLC), UV detection at 280 nm, Zorbax 300SB-C3 column. Immunoturbidimetric analysis was performed using commercial kit on automatic biochemistry analyzer COBAS INTEGRA^® 400, Roche Diagnostics GmbH, Manheim, Germany.

RESULTS

The HLPC method was fully validated. No significant interference with other proteins (transferrin, α-1-acid glycoprotein, α-1-antichymotrypsin, antitrypsin, hemopexin) was found. The results from 301 urine samples were compared with immunochemical determination. We found a statistically significant difference between these methods (P = 0.0001, Mann-Whitney test).

CONCLUSION

New simple HPLC method was developed for the determination of urine albumin without coeluting proteins. Our data indicate that the HPLC method is highly specific and more sensitive than immunoturbidimetry.

Quantitation of Albumin in Urine by Liquid Chromatography Tandem Mass Spectrometry

Urinary excretion of human serum albumin (HSA), a 6.65 kDa monomeric protein, is a sensitive marker of renal damage associated with many diseases including diabetes mellitus. Albumin is synthesized by the liver and functions as a transport protein for fat-soluble hormones and drugs and for maintaining plasma colloid osmotic pressure and pH. Albumin is not filtered at the glomerulus and its presence in the urine at concentration above 30 mg/day is suggestive of glomerular damage. Early diagnosis of microalbuminuria (30-300 mg/24 h urine albumin excretion or 30-300 mg/g creatinine in random collections) has prognostic value for monitoring disease progression and early clinical management of diabetic nephropathy in prediabetic patients. Current methods for quantitation of urine albumin are based on immunoassays or size exclusion high-performance liquid chromatography coupled with UV detection (SEC-HPLC-UV). Studies have demonstrated discordance between the existing methods. It has been suggested that while immunoassays underestimate albumin in urine, SEC-HPLC-UV method overestimates albumin as it cannot separate co-eluting interferences. This chapter describes a liquid chromatography tandem mass spectrometry LC-MS/MS candidate reference method for albumin quantitation.

High-performance liquid chromatography as a technique to determine protein adsorption onto hydrophilic/hydrophobic surfaces

The purpose of this study is to evaluate the potential of simple high performance liquid chromatography (HPLC) setup for quantification of adsorbed proteins on various type of plane substrates with limited area (<3 cm(2)). Protein quantification was investigated with a liquid chromatography chain equipped with a size exclusion column or a reversed-phase column. By evaluating the validation of the method according to guidelines of the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH), all the results obtained by HPLC were reliable. By simple adsorption test at the contact of hydrophilic (glass) and hydrophobic (polydimethylsiloxane: PDMS) surfaces, kinetics of adsorption were determined and amounts of adsorbed bovine serum albumin, myoglobin and lysozyme were obtained: as expected for each protein, the amount adsorbed at the plateau on glass (between 0.15 μg/cm(2) and 0.4 μg/cm(2)) is lower than for hydrophobic PDMS surfaces (between 0.45 μg/cm(2) and 0.8 μg/cm(2)). These results were consistent with bicinchoninic acid protein determination. According to ICH guidelines, both Reversed Phase and Size Exclusion HPLC can be validated for quantification of adsorbed protein. However, we consider the size exclusion approach more interesting in this field because additional informations can be obtained for aggregative proteins. Indeed, monomer, dimer and oligomer of bovine serum albumin (BSA) were observed in the chromatogram. On increasing the temperature, we found a decrease of peak intensity of bovine serum albumin as well as the fraction of dimer and oligomer after contact with PDMS and glass surface. As the surface can act as a denaturation parameter, these informations can have a huge impact on the elucidation of the interfacial behavior of protein and in particular for aggregation processes in pharmaceutical applications.

The impacts of albuminuria and low eGFR on the risk of cardiovascular death, all-cause mortality, and renal events in diabetic patients: meta-analysis

BACKGROUND

Precise effects of albuminuria and low estimated glomerular filtration rate (eGFR) on cardiovascular mortality, all-cause mortality, and renal events in diabetic patients are uncertain.

MATERIALS AND METHODS

A systematic review was conducted of the literature through MEDLINE, EMBASE, and CINHAL from 1950 to December 2010. Cohort studies of diabetic patients providing adjusted relative risk (RR) of albuminuria and eGFR for risks of cardiovascular mortality, all-cause mortality, and renal events were selected. Two reviewers screened abstracts and full papers of each study using standardized protocol.

RESULTS

We identified 31 studies fulfilling the criteria from 6546 abstracts. With regard to the risk of cardiovascular mortality, microalbuminuria (RR 1.76, 95%CI 1.38-2.25) and macroalbuminuria (RR 2.96 95%CI 2.44-3.60) were significant risk factors compared to normoalbuminuria. The same trends were seen in microalbuminuria (RR 1.60, 95%CI 1.42-1.81), and macroalbuminuria (RR 2.64, 95%CI 2.13-3.27) for the risk of all-cause mortality, and also in microalbuminuria (RR 3.21, 95%CI 2.05-5.02) and macroalbuminuria (RR 11.63, 95%CI 5.68-23.83) for the risk of renal events. The magnitudes of relative risks associated with low eGFR along with albuminuria were almost equal to multiplying each risk rate of low eGFR and albuminuria. No significant factors were found by investigating potential sources of heterogeneity using subgroup analysis.

CONCLUSIONS

High albuminuria and low eGFR are relevant risk factors in diabetic patients. Albuminuria and low eGFR may be independent of each other. To evaluate the effects of low eGFR, intervention, or race, appropriately designed studies are needed.

Cytokine assays: an assessment of the preparation and treatment of blood and tissue samples

Cytokines are key components of the innate and adaptive immune system. As pivotal players in the progression or regression of a pathological process, these molecules provide a window through which diseases can be monitored and can thus act as biomarkers. In order to measure cytokine levels, a plethora of protocols can be applied. These methods include bioassays, protein microarrays, high-performance liquid chromatography (HPLC), sandwich enzyme-linked immunosorbent assay (ELISA), Meso Scale Discovery (MSD) electrochemiluminescence and bead based multiplex immunoassays (MIA). Due to the interaction and activity of cytokines, multiplex immunoassays are at the forefront of cytokine analysis by allowing multiple cytokines to be measured in parallel. However, even with optimized protocols, sample standardization needs to occur before these proteins can optimally act as biomarkers. This review describes various factors influencing the levels of cytokines measured in plasma, serum, dried blood spots and tissue biopsies, focusing on sample collection and handling, long term storage and the repetitive use of samples. By analyzing how each of these factors influences protein levels, it is concluded that samples should be stored at low temperatures in order to maintain cytokine stability. In addition, within a study, sample manipulations should be kept the same, with measurement protocols being chosen for their compatibility with the research in question. By having a clear understanding of what factors influence cytokine levels and how to overcome these technical issues, minimally confounded data can be obtained and cytokines can achieve optimal biomarker activity.

The value of simultaneous measurements of urinary albumin and total protein in proteinuric patients

BACKGROUND

Proteinuria is a common pathological finding in renal disease. Examining the urinary protein electrophoretic pattern gives clues to the site of origin of the protein. We hypothesized that the type of proteinuria, classified by urine protein electrophoresis and immunofixation (uPEI), may be predicted by simply examining the proportion of higher molecular weight protein (e.g. albumin) in urine total protein content.

METHODS

One thousand and eleven patients, whose urine had been sent to the pathology department for uPEI, were analysed for total protein and albumin to creatinine ratio (uPCR and uACR) and the ratio reported as the albumin to total protein ratio (uAPR). In a group of renal outpatients (n=248), we also specifically measured tubular proteins (N-acetyl-β-D-glucosaminidase, NAG, and β2-microglobulin) and expressed these as ratios to creatinine (uNCR and uβ2CR). To validate these findings, we correlated these measurements with 68 patients in whom we also had renal biopsy data.

RESULTS

In receiver operating characteristic (ROC) curve analysis, the AUC for uAPR was 0.84 for predicting tubular proteinuria pattern on uPEI. In the renal outpatient subgroup, uAPR predicted a tubular pattern of urinary protein equally as well as testing for specific tubular protein markers (uNCR and uβ2CR). In the validation cohort, a uAPR cut-off of <0.40 was 88% sensitive and 99% specific for the diagnosis of primary tubulointerstitial disorders on renal biopsy.

CONCLUSIONS

Useful information about the origins of urinary protein may be inferred by measuring uAPR, the measurement of which is both simple and inexpensive.

Immunochemically unreactive albumin in urine: fiction or reality?

Urinary albumin measurements are currently not standardized due to a lack of a reference method and reference (primary and secondary [matrix]) material. Multiple molecular forms of albumin in urine are identified. Modification of albumin by proteolysis during passage through the urinary tract and chemical modification during specimen storage leads to the formation of albumin fragments. Multiple methods have been developed to quantify albuminuria and significant different results are reported dependent on the available assay. The current point of view of the National Kidney Disease Education Program - IFCC Working Group on Standardization of Albumin considers the immunoassay with polyclonal sera as the primary method of quantifying urine albumin. This article reviews the process of albumin fragmentation and focuses on the controversial topic of immuno-unreactive, nonimmunoreactive, or immunochemically nonreactive albumin fractions and its consequences for albumin analysis. We conclude that at present there are no hard arguments for measuring immunochemically unreactive albumin in urine. Immunoassays using polyclonal antisera for the detection of urinary albumin remain the gold standard. The development of a reference measurement procedure remains one of the challenges for the future.

Mass spectrometry of peptides and proteins from human blood

It is difficult to convey the accelerating rate and growing importance of mass spectrometry applications to human blood proteins and peptides. Mass spectrometry can rapidly detect and identify the ionizable peptides from the proteins in a simple mixture and reveal many of their post-translational modifications. However, blood is a complex mixture that may contain many proteins first expressed in cells and tissues. The complete analysis of blood proteins is a daunting task that will rely on a wide range of disciplines from physics, chemistry, biochemistry, genetics, electromagnetic instrumentation, mathematics and computation. Therefore the comprehensive discovery and analysis of blood proteins will rank among the great technical challenges and require the cumulative sum of many of mankind's scientific achievements together. A variety of methods have been used to fractionate, analyze and identify proteins from blood, each yielding a small piece of the whole and throwing the great size of the task into sharp relief. The approaches attempted to date clearly indicate that enumerating the proteins and peptides of blood can be accomplished. There is no doubt that the mass spectrometry of blood will be crucial to the discovery and analysis of proteins, enzyme activities, and post-translational processes that underlay the mechanisms of disease. At present both discovery and quantification of proteins from blood are commonly reaching sensitivities of ∼1 ng/mL.

Development of a colloidal gold-based immunochromatographic test strip for screening of microalbuminuria

A rapid immunochromatography (ICG) assay based on antibody colloidal gold nanoparticles specific to human serum albumin (HSA) was developed, and its applications for primary screening of HSA in the urine were evaluated. A monoclonal antibody (MAb) specific to HSA was produced from cloned hybridoma cells (EMRC1) and used to develop an ICG strip. The nanocolloidal gold, with an average particle diameter of 20 nm, was synthesized and labeled MAb as the detection reagent. An antibody colloidal gold probe was applied on the conjugate pad, and HSA antigen was immobilized to a nitrocellulose membrane as the capture reagent to prepare the ICG strip test. This test required only 10 min to accomplish a semiquantitative detection of albumin. The sensitivity to urinary albumin was found to be approximately 20 μg/mL, and the analytical range was 20-25 μg/mL. The reliability of the testing procedures was examined by carrying out the ICG strip test with 40 urine samples and comparing the results of these tests with those obtained via immunoturbidimetry. The ICG strip was adequately sensitive and accurate for a rapid screening of HSA in the urine.

Assessment of proteinuria

Proteinuria is a strong predictor of adverse cardiovascular and kidney events, and an accurate assessment of proteinuria is important for the evaluation and management of CKD. Total urinary protein can be assessed using dipstick, precipitation, and electrophoresis methods. Urinary albumin, the predominant urinary protein in most proteinuric kidney diseases, can be assessed using an albumin-specific dipstick, immunochemical techniques, and size-exclusion high-performance liquid chromatography. Urine albumin may be immune-reactive, immune-unreactive, fragmented, and biochemically modified, and laboratory techniques have variable abilities to detect different types of albumin. Urine specimen for proteinuria assessment can either be obtained from a timed-collection or a spot urine sample. Spot urine protein- or albumin-to-creatinine ratios are preferred to a 24-hour urine sample in routine practice. Assessment of albuminuria rather than proteinuria is more clinically meaningful in patients with diabetic kidney disease, and proteinuria and albuminuria assessments both have a role in nondiabetic kidney disease and in general population screening. As measurement and sampling procedures for proteinuria assessment have yet not been standardized, it is important for physicians to be aware of different types of urinary proteins, albumins, laboratory techniques, and urine sampling methods.

Human plasma copper proteins speciation by size exclusion chromatography coupled to inductively coupled plasma mass spectrometry. Solutions for columns calibration by sulfur detection

Among the hyphenated techniques used to probe and identify metalloproteins, size exclusion chromatography coupled to inductively coupled plasma mass spectrometry (SEC-ICP-MS) has shown to have a central place. However, the calibration of SEC columns reveals to be tedious and always involves UV detection prior to ICP-MS. The presence of sulfur in 98% of proteins allows their detection by quadrupole ICP-MS, despite the isobaric interference ((16)O(16)O) on S, by monitoring (32)S(16)O at mass to charge ratio (m/z) 48. The formation of SO occurs spontaneously in the argon plasma but can be optimized by the introduction of oxygen gas into a reaction cell (RC) to achieve nM levels. In this article, sulfur detection was discussed upon instrumental conditions and S detection was then optimized by applying O(2) as a reaction gas. SO formation was used to calibrate SEC columns without UV detection. This simple SEC-ICP-MS method was used for plasma copper proteins in plasma healthy subjects (HS) and an untreated Wilson disease (WD) patient. Copper proteins identified in healthy subjects were transcuprein, ceruloplasmin (Cp) and albumin. The method led to results in good agreement with other methods of determination. Copper bound to Cp in the WD patient was lowered with regard to the HS, and the exchangeable Cu was highly increased.

Potential urinary biomarkers of disease activity in Crohn's disease

OBJECTIVE

Measurement of the immunoreactive urinary albumin (ir-uAlb) concentration by immunological methods was found to be an effective method to identify disease activity in Crohn's disease (CD). Recently a size-exclusion (SE) high performance liquid chromatography (HPLC) method was developed to measure both ir-uAlb and non-immunoreactive urinary albumin (total, t-uAlb). We aimed to follow-up one of our CD patients with frequent remissions and exacerbation phases comparing the changes of disease activity parameters and the concentration of ir-uAlb and t-uAlb. The surprising results led us to perform measurements in greater depth.

MATERIAL AND METHODS

Concentration of ir-uAlb was measured by immunoturbidimetry (IT) and t-uAlb by SE-HPLC. Albumin peak of SE-HPLC was collected and applied to a reversed-phase (RP) HPLC and to gel-electrophoresis. Eluted peaks of RP-HPLC and identified bands of gel-electrophoresis were analyzed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS).

RESULTS

The concentration of t-uAlb was 15 times higher than that of the ir-uAlb during active state. The RP-HPLC and the gel-electrophoresis separation proved that albumin peak by size-exclusion consists of three different peaks. MALDI-TOF/MS measurements identified α1-acid-glycoprotein and Zn-α2-glycoprotein as major, and albumin as minor protein.

CONCLUSIONS

Peak of albumin of SE-HPLC contains a significant amount of glycoprotein during the active phase of CD, which could not be detected in remission. Urinary α1-acid-glycoprotein and/or Zn-α2-glycoprotein could be an ideal disease activity biomarker of CD.

Urinary proteases degrade albumin: implications for measurement of albuminuria in stored samples

BACKGROUND

Previous studies have shown that albumin in stored urine samples degrades over time, and that albumin losses are greatest in samples with low pH conditions (pH < 5). Furthermore, the high-performance liquid chromatography (HPLC) assay for urinary albumin has been shown to be particularly susceptible to the effects of prolonged storage.

METHODS

Frozen urine samples, stored for 12 months at -70 and -20 degrees C, were analysed for albumin fragmentation. Urinary protease activity was investigated in vitro in urine adjusted to pH 2.3-2.5. Albumin was measured by nephelometry, HPLC and sodium dodecyl sulphate-polyacrylamide gel electrophoresis.

RESULTS

In the unadjusted samples, albumin was degraded in 11 out of 40 samples stored at -20 degrees C. In the in vitro experiments, both endogenous albumin and exogenous albumin added to urine were rapidly degraded into large fragments within minutes after adjustment to low pH. The fragments produced were consistent with those produced during digestion with pepsin and urinary degradation was completely inhibited by pepstatin. Albumin concentration measured by HPLC was most dramatically affected, with near-complete loss of albumin-sized material within one hour of incubation at pH 2.3-2.5. Sample reactivity with antiserum in a nephelometry assay initially declined then increased, possibly due to exposure of internal epitopes during albumin digestion.

CONCLUSIONS

This study demonstrated that proteases are present and active in stored human urine samples. Urinary albumin digestion occurred in a manner consistent with activity of endogenous urinary proteases. Adjustment to neutral pH or addition of protease inhibitors may be useful techniques for sample preservation.

Glomerular filtration rate measurement and prediction equations

Chronic kidney disease (CKD) is defined as the presence of kidney damage or a glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) for three or more months. Measurement of serum creatinine is the most commonly used method to evaluated kidney function, but it must be included in formulas to estimate GFR, adjusting for age, gender and ethnicity, such as the Modification of Diet in Renal Disease (MDRD) study equation. The performance of this equation is acceptable for patients with CKD but appears to under-estimate GFR in populations with unknown kidney status. A new formula has been developed recently. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation appears to perform better than the MDRD equation. Cystatin C has been widely evaluated as a marker for GFR and seems to be more sensitive than creatinine. The aim of this review is to discuss the recommendations for detecting CKD, emphasizing the characteristics and limitations of GFR estimating equations and pitfalls in the evaluation of urinary albumin excretion.

Combination of 1H nuclear magnetic resonance spectroscopy and liquid chromatography/mass spectrometry with pattern recognition techniques for evaluation of metabolic profile associated with albuminuria

A method using 1H NMR and LC/MS with pattern recognition tools such as principal component analysis (PCA) and orthogonal projection to latent structure discriminant analysis (O-PLS-DA) was used to study the urinary metabolic profiles associated with an increase in urinary albumin in a general population. The normalized peak intensities obtained from 1H NMR and LC/MS with nonparametric two-tailed Mann-Whitney analysis was used for the identification of network of potential biomarkers corresponding to the increase of albumin in urine. The specificity of detecting the stated metabolites by 1H NMR and LC/MS was demonstrated. Our preliminary data obtained demonstrated that LC/MS may produce more distinctive metabolic profiles. For the patient group, changes in alanine, kyneurnic acid, and xanthurenic acid might be associated with changes in the tryptophan metabolism. At the same time, other metabolites that were involved in citric acid cycle, amino acid metabolism, and cellular functions were affected in the patient group. The proposed approach provided a comprehensive picture of the metabolic changes induced by the increase of protein in urine and demonstrated the advantages of using multiple diagnostic biomarkers. At the same time, the current work was demonstrated as a potential cost-effective solution of high-throughput analysis with pattern recognition tools as applied here in a real clinical situation.

Human serum proteins fractionated by preparative partition chromatography prior to LC-ESI-MS/MS

Many proteomics studies are limited to the identification of only the most abundant proteins in a sample due to the high sample complexity in most proteomes. We have here addressed this problem by prefractionation of human blood samples using microchromatography. We show that our approach resulted in high-stringency tryptic peptides identified by LC-ESI-MS/MS. Serum proteins were fractionated by batch and stepwise preparative chromatography using various types of chromatography resins (propyl sulfate, quaternary amine, diethylaminoethanol, cibachron blue, phenol Sepharose, carboxy methyl sepharose, hydroxyl apatite, heparin, concanavalin A and protein G) that were compared. The efficacy of sample fractionation was determined by protein assays, electrophoresis, and mass spectrometry. Tryptic peptides were separated by C18 liquid chromatography with electrospray ionization via metal needle at 2 microL/min with ion trap tandem mass spectrometry. The MS/MS spectra were correlated to some 4396 distinct sequences of the human forward RefSeq by X!TANDEM. Of these, 61% have been detected by other algorithms, but 3219 (73%) were never previously reported from blood by X!TANDEM. The use of a simple apparatus for making gravity microchromatography columns that permits the rapid side-by-side fractionation of many serum samples is described. Disposable microcolumns rapidly prepared blood samples for LC ESI-MS/MS that detected both tissue and cell leakage proteins known to exist in the approximately 1 ng/mL range and some circulating receptor sequences. Our results demonstrate that the depletion of albumin or IgG was not necessary prior to LC-MS/MS and that multiple forms of protein chromatography will be useful for complete identification of blood proteins.

How should proteinuria be detected and measured?

Proteinuria is a classic sign of kidney disease and its presence carries powerful prognostic information. Although proteinuria testing is enshrined in clinical practice guidelines, there is surprising variation among such guidelines as to the definition of clinically significant proteinuria. There is also poor agreement as to whether proteinuria should be defined in terms of albumin or total protein loss, with a different approach being used to stratify diabetic and non-diabetic nephropathy. Further, the role of reagent strip devices in the detection and assessment of proteinuria is unclear. This review explores these issues in relation to recent national and international guidelines on chronic kidney disease (CKD) and epidemiological evidence linking proteinuria and clinical outcome. The authors argue that use of urinary albumin measurement as the front-line test for proteinuria detection offers the best chance of improving the sensitivity, quality and consistency of approach to the early detection and management of CKD.

Albuminuria: what can we expect from the determination of nonimmunoreactive albumin?

Albuminuria is an early marker for diabetic nephropathy in patients with diabetes, and has a clear place in patient care. It also predicts cardiovascular events and mortality in diabetic patients and in the general population, and is slowly becoming accepted in population screening for cardiovascular disease and chronic kidney disease. Recently, investigators found that a considerable amount of albumin in urine is nonimmunoreactive and that classic immunochemical assays do not properly measure all albumin in urine. Assays that detect immunoreactive plus nonimmunoreactive albumin may better predict development of diabetic nephropathy, cardiovascular events, and mortality than assays that only detect immunoreactive albumin. Proof of the existence of nonimmunoreactive albumin emerged from the finding that albumin contains urine fragments. In this review, we critically appraise the presence and relevance of albumin fragments and nonimmunoreactive albumin molecules in urine, and the potential additive value of albuminuria detected by assays that assess nonimmunoreactive plus immunoreactive albumin over albuminuria detected by classic immunochemical assays in predicting end points.

Proteinuria without albuminuria: urinary protein excretion by a subset of patients with burn injuries

BACKGROUND

There is disagreement regarding the utility of urinary albumin excretion as a marker for capillary injury in patients with severe burn injuries. We examined protein components in urine specimens from patients with burn injury.

METHODS

Detailed analysis was performed for a set of 5 urine specimens selected based on a high ratio of albumin-sized molecules by size-exclusion HPLC (Accumin) versus albumin by immunoassay methods. Specimens were analyzed for total protein, alpha(1)-microglobulin, alpha(1)-acid glycoprotein, cystatin C, and retinol-binding protein. Urine components were analyzed by chromatographic and electrophoretic methods. Major components were identified by mass spectrometry of tryptic peptides.

RESULTS

A subset of urine specimens had increased total protein with slight increases in albumin by immunoassay or by polyacrylamide gel electrophoresis. Albumin values by size-exclusion HPLC were more than 10-fold higher. Immunoassays for alpha(1)-microglobulin and alpha(1)-acid glycoprotein yielded concentrations 5-10 fold higher than for albumin. Other major components identified included zinc-alpha(2)-glycoprotein and leucine-rich-alpha(2)-glycoprotein.

CONCLUSIONS

A subset of patients with burn injury had increased total urinary protein resulting primarily from increased excretion of proteins such as alpha(1)-microglobulin and alpha(1)-acid glycoprotein with little increase in albumin excretion. The unusual composition of urinary proteins in these patients may relate to decreased filtered load of albumin and increased filtered load of acute phase reactants or to alterations in renal tubular protein processing. Thus, measurement of urinary albumin may have decreased sensitivity for detecting kidney injury in burn patients.

Current issues in measurement and reporting of urinary albumin excretion

BACKGROUND

Urinary excretion of albumin indicates kidney damage and is recognized as a risk factor for progression of kidney disease and cardiovascular disease. The role of urinary albumin measurements has focused attention on the clinical need for accurate and clearly reported results. The National Kidney Disease Education Program and the IFCC convened a conference to assess the current state of preanalytical, analytical, and postanalytical issues affecting urine albumin measurements and to identify areas needing improvement.

CONTENT

The chemistry of albumin in urine is incompletely understood. Current guidelines recommend the use of the albumin/creatinine ratio (ACR) as a surrogate for the error-prone collection of timed urine samples. Although ACR results are affected by patient preparation and time of day of sample collection, neither is standardized. Considerable intermethod differences have been reported for both albumin and creatinine measurement, but trueness is unknown because there are no reference measurement procedures for albumin and no reference materials for either analyte in urine. The recommended reference intervals for the ACR do not take into account the large intergroup differences in creatinine excretion (e.g., related to differences in age, sex, and ethnicity) nor the continuous increase in risk related to albumin excretion.

DISCUSSION

Clinical needs have been identified for standardization of (a) urine collection methods, (b) urine albumin and creatinine measurements based on a complete reference system, (c) reporting of test results, and (d) reference intervals for the ACR.

New and old markers of progression of diabetic nephropathy

The onset of diabetic nephropathy is characterised by a rise in albumin excretion rate (AER) and/or a transient rise in glomerular filtration rate (GFR) (hyperfiltration). Without intervention AER increases exponentially and there is a linear decrease in GFR after onset of overt nephropathy. In overt nephropathy, AER is a predictor of decline in GFR and the early AER response to antihypertensive therapy correlates with long-term decline in GFR. AER can be measured by immunoassay or by other techniques including HPLC. However, HPLC assays result in higher levels of AER in normal subjects compared with immunoassayable AER. Recent data suggest that there are distinct albuminuric and non-albuminuric pathways to renal impairment in type 1 and type 2 diabetes. In type 2 diabetes, the non-albuminuric pathway may explain a decline in GFR to <60 ml/min/1.73 m(2) in approximately one in four subjects after accounting for the use of renin angiotensin system inhibitors. In established nephropathy (chronic kidney disease (CKD) stages 3 and 4), plasma cystatin C based estimates of GFR are marginally superior to creatinine based estimates. However, cystatin C clearly outperforms creatinine based estimates of GFR decline at GFR levels >60 ml/min/1.73 m(2) (CKD stages 1 and 2). Other potential markers of progression of diabetic nephropathy include transforming growth factor beta (TGFbeta) and connective tissue growth factor (CTGF). However, long-term studies are needed to define their roles as markers of progression. Diabetic nephropathy is likely to be more susceptible to intervention at an early stage and accurate estimation of GFR is already possible with cystatin C. However, improved formulas for estimating GFR based on using creatinine or other markers are still required, because this may still provide the most cost effective approach applicable to existing clinical practice.

Resonance scattering detection of trace microalbumin using immunonanogold probe as the catalyst of Fehling reagent-glucose reaction

A novel and sensitive resonance scattering (RS) spectral immunoassay for the determination of microalbumin (Malb) was developed, based on the catalytic effect of immunonanogold (ING) probe on Fehling reagent-glucose reaction, and resonance scattering effect of Cu(2)O particles. Nanogold particles in size of 10nm were used to label goat anti-human microalbumin (GMalb) to obtain an ING probe (AuGMalb) for Malb. The probe produced unspecific aggregation in pH 5.0 citric acid-Na(2)HPO(4) buffer solutions. Upon addition of Malb, the dispersed ING complex formed. The ING complex in supernatant was obtained by centrifuging and was used as catalyst for the reaction between Fehling reagent and glucose to form the Cu(2)O particles to amplify the resonance scattering signal at 610 nm. With addition of Malb, the ING complex in the supernatant increased and the RS intensity at 610 nm (I(610 nm)) enhanced linearly. The enhanced intensity DeltaI(610 nm) was proportional to the Malb concentration in the range of 0.014-0.43 ng ml(-1), with a detection limit of 7.2 pg ml(-1). The proposed method was applied to detect Malb in human urine sample with satisfactory results.

Comparison between immunoturbidimetry, size-exclusion chromatography, and LC-MS to quantify urinary albumin

BACKGROUND

The accurate and precise measurement of urinary albumin is critical, since even minor increases are diagnostically sensitive indicators of renal disease, cardiovascular events, and risk for death. To gain insights into potential measurement biases, we systematically compared urine albumin measurements performed by LC-MS, a clinically available immunoturbidimetric assay, and size-exclusion HPLC.

METHODS

We obtained unused clinical urine samples from 150 patients who were stratified by degrees of albuminuria (<20 mg/L, 20-250 mg/L, >250 mg/L) as determined by the immunoturbidimetric assay used in our clinical laboratory (Roche Hitachi 912). Urine albumin was then remeasured via LC-MS and HPLC (Accumin) assays.

RESULTS

The immunoturbidimetric assay, calibrated using manufacturer-supplied serum-derived calibrators (Diasorin), underestimated albumin compared with LC-MS. After calibration with purified HSA, this immunoturbidimetric assay correlated well with LC-MS. HPLC overestimated albumin compared with both LC-MS and immunoturbidimetry. The current LC-MS and HPLC assays both performed poorly at concentrations <20 mg/L.

CONCLUSIONS

Efforts are needed to establish gold-standard traceable calibrators for clinical assays. LC-MS is a specific method to quantify albumin in native urine when concentrations exceed 20 mg/L, and therefore could be employed for standardization among assays.

Analysis of microalbuminuria with immunonephelometry and high performance liquid chromatography. Evaluation of new criteria

Mind a hipertónia, mind a 2-es típusú diabetes mellitus jelentős tényező a népesség halálozásában. Mindkét betegség károsítja az endothelt, aminek korai jele a microalbuminuria, amelyet szűrővizsgálatként tesztcsíkkal, diagnosztikus vizsgálatként immunológiai alapú módszerekkel, illetve nagy teljesítményű folyadékkromatográfiával lehet mérni. Ez utóbbi segítségével az ún. nem immunreaktív albuminforma is kimutatható. Célkitűzés: A szerzők célkitűzése immunnefelometriával microalbuminuriára negatív, diabéteszes és hipertóniás, illetve nem diabéteszes hipertóniás betegek albuminürítésének vizsgálata volt nagy teljesítményű folyadékkromatográfiával. Továbbá célul tűzték ki a microalbuminuria megállapításához használt jelenlegi kritériumok (albumin-kreatinin hányados: férfiaknál ≥2,5 mg/mmol, nőknél ≥3,5 mg/mmol) és a közelmúltban megjelent Heart Outcomes Prevention Evaluation tanulmány által javasolt új kritériumok (nem diabéteszesekben, immunológiai módszerrel ≥0,7 mg/mmol, nagy teljesítményű folyadékkromatográfiás módszerrel ≥3,1 mg/mmol, diabéteszesekben immunológiai módszerrel ≥1,4 mg/mmol, nagy teljesítményű folyadékkromatográfiával ≥5,2 mg/mmol) használhatóságának vizsgálatát is. Módszer: Szűrővizsgálattal microalbuminuriára negatív 469 egyén vizeletének vizsgálata történt meg immunnefelometriás módszerrel. Az így is negatívakat vizsgálták tovább nagy teljesítményű folyadékkromatográfián alapuló, a méretkizárásos kromatográfia elvén működő Accumin™ Kit-tel. Eredmények: Nagy teljesítményű folyadékkromatográfiával átlagosan háromszor nagyobb albuminürítést mértek, mint immunnefelometriával. Az intraindividuális variációs koefficiens a két módszerrel nem különbözött (37 ± 31% és 40 ± 31%, p = 0,869; immunnefelometria és nagy teljesítményű folyadékkromatográfia; átlag ± szórás). A jelenlegi albumin-kreatinin hányadoson alapuló kritériumokat használva, az immunológiai módszerrel negatív egyének nagy teljesítményű folyadékkromatográfiával 43%-ban bizonyultak pozitívnak. Ha a Heart Outcomes Prevention Evaluation tanulmány új kritériumait használták, 14,5%-ra csökkent az immunnefelometriával negatív, nagy teljesítményű folyadékkromatográfiával pozitívak aránya; nagy teljesítményű folyadékkromatográfiával microalbuminuria-pozitívak száma elsősorban a diabéteszes és hipertóniás csoportban csökkent (49% és 7,5%), míg a nem diabéteszes hipertóniás csoportban kevésbé (37% és 26,5%). A hagyományos kritériumrendszerben logisztikus regressziós vizsgálat során a legerősebb kockázati faktornak a férfinem bizonyult. Az immunnefelometriával microalbuminuriára negatív egyének 28%-ában nagy teljesítményű folyadékkromatográfiával kimondható a microalbuminuria diagnózisa a jelen szakmai szabályok szerint. Következtetések: Az immunológiai módszerekkel microalbuminuriára negatív egyének közel harmadában nagy teljesítményű folyadékkromatográfiával kimondható a microalbuminuria diagnózisa, amihez továbbra is szükséges a háromszori vizeletvizsgálat. A Heart Outcomes Prevention Evaluation tanulmány által megállapított új kritériumok sem a diabéteszes és hipertóniás betegekre, sem a nem diabéteszes hipertóniás betegekre nem alkalmazhatók jól. Nem lehet figyelmen kívül hagyni a microalbuminuria-pozitivitás legjelentősebb prediktorát, a nemet.

Reactivity of Urinary Albumin (Microalbumin) Assays with Fragmented or Modified Albumin

Background: Controversy exists regarding occurrence and measurement of structural variants of albumin in urine. In this study, we examined cross-reactivity of in vitro modified albumins in assays for urine albumin (microalbumin).

Methods: We analyzed albumin modified by reagents, trypsin, or physical treatments or differing in primary sequence (animal albumins) with an immunoturbidimetric assay (Beckman LX20) using goat antiserum and a competitive immunoassay (Siemens Immulite) using a monoclonal antibody. We assessed occurrence of albumin fragments in urine by use of Western blotting of 24 specimens.

Results: Chemical modification, modest sequence substitution (gorilla albumin), or cleavage of albumin by cyanogen bromide (CNBr) had little effect on reactivity in the LX20 assay. Albumin extensively cleaved with trypsin retained partial reactivity. The Immulite assay generally was affected more severely by albumin modifications and sequence changes. Western blots of fresh urine specimens or specimens stored at −80 °C showed little albumin fragmentation, but some specimens stored for 3 years at −20 °C had extensively fragmented albumin that was detected by the LX20 but not the Immulite assay.

Conclusions: Nearly equivalent reactivity of intact albumin and CNBr fragments in the immunoturbidimetric assay indicates reactivity of antibodies with multiple epitopes throughout albumin. Therefore, it is difficult to abolish reactivity of albumin in this type of urine albumin assay. Differential sensitivity of 2 assays to albumin modification identifies a potential source of assay nonequivalence in measuring urinary albumin, particularly for specimens stored at −20 °C.

HPLC-detected albuminuria predicts mortality

Albuminuria is a risk factor for all-cause mortality. Urinary albumin is traditionally measured with an immunochemical method such as immunonephelometry (IN). High-performance liquid chromatography (HPLC) detects additional albumin that is missed by IN, but it is unknown if HPLC-detected albuminuria also predicts mortality in the general population. We measured urinary albumin at baseline with both IN and HPLC in 10,175 participants in the longitudinal Australian Diabetes, Obesity, and Lifestyle (AusDiab) study. Over 5.2 yr of follow-up, 319 participants died. In a Cox proportional hazards regression model, participants with albuminuria measured by IN or HPLC were approximately twice as likely to die as participants who were normoalbuminuric on both assays. Receiver-operator characteristic curve analyses suggest that each test has a similar ability to predict mortality. However, the HPLC assay provided information on mortality risk that the IN assay did not capture. We conclude that albuminuria, detected by either IN or HPLC, independently predicts mortality in a community-based sample. HPLC identifies some people at increased risk of mortality that IN would not detect.

Endogenous peptides from biophysical and biochemical fractionation of serum analyzed by matrix-assisted laser desorption/ionization and electrospray ionization hybrid quadrupole time-of-flight

Blood peptides can be concentrated, extracted, and analyzed with strong signal-to-noise ratios by precipitation in organic solvents followed by extraction in water. Matrix-assisted laser desorption/ionization (MALDI) and electrospray ionization (ESI) hybrid quadrupole time-of-flight (Qq-TOF) were used to analyze the precipitated and extracted endogenous peptides from fetal calf serum. C18 solid-phase extraction with or without prior precipitation in ammonium sulfate, size exclusion chromatography, dealbuminization, dye affinity chromatography, ultrafiltration, and differential precipitation in organic solvents were compared. Hundreds of different ions could be observed by MALDI in the various fractions. It appeared that some peptides were freely dissolved and that not all peptides in blood were obliged to remain bound to albumin or other high-molecular-mass proteins. Mass spectra with high signal-to-noise ratios were obtained from polypeptides precipitated with organic solvents followed by extraction of the peptides from the pellet with water. The peptides extracted from organic precipitates were analyzed by nano liquid chromatography (LC)-ESI-Qq-TOF. In addition to many commonly abundant serum proteins, apparent low-abundance peptides associated with cancer biology from proteins such as insulin-like growth factor II, thymosin beta4 and beta9, plasminogen, coagulation factors, and extracellular matrix protein 1 were observed.

Production and Characterization of Monoclonal Antibody Against Human Serum Albumin

Hybridomas secreting monoclonal antibodies (MAbs) producing stable, specific and high affinity against human serum albumin (HSA) have been established. The aim of the present study was the production of MAbs that will be potentially used in designing immunoassay methods especially immunochromatography assay kit for screening of microalbuminuria (MAU) in the early detection of diabetic and nondiabetic nephropathy. The hybridomas were obtained by fusion of spleen cells from immunized mice with mouse myeloma cell line (SP2). After limiting dilutions three clones producing antibodies were designed as EMRC1-3, which displayed different pattern of fine specificity for HSA and low cross reaction with other proteins as elucidated by inhibition enzyme-linked immunosorbent assay (ELISA). These clones were found to be of immunoglobulin G (IgG) class with k light chain. Subclass determination showed that all three MAbs secreted IgG1 type of antibody. The results of affinity purification for the two selected clones (EMRC1 and EMRC3) displayed high affinity with no cross reactivity with any of the related protein molecules. The stable hybridomas secreting anti-HSA were expanded in 50-mL flasks for large-scale production of the required antibodies. The standard curves were constructed with a sensitivity of 10 pg per well covering up to 100 ng per well. The high binding activity to HSA antigen and having no cross reactivity with other related molecules illustrated the potential application of these antibodies as an immunodiagnostic reagent in designing an immunochromatography assay kit for screening of MAU in diabetic and nondiabetic patients.

Tear analysis and lens–tear interactions

The purpose of this work is to establish the application of a fully automated microfluidic chip based protein separation assay in tear analysis. It is rapid, requires small sample volumes and is vastly superior to, and more convenient than, comparable conventional gel electrophoresis assays. The protein sizing chip technology was applied to three specific fields of analysis. Firstly tear samples were collected regularly from subjects establishing the baseline effects of tear stimulation, tear state and patient health. Secondly tear samples were taken from lens wearing eyes and thirdly the use of microfluidic technology was assessed as a means to investigate a novel area of tear analysis, which we have termed the 'tear envelope'. Utilising the Agilent 2100 Bioanalyzer in combination with the Protein 200 Plus LabChip kit, these studies investigated tear proteins in the range of 14-200 kDa. Particular attention was paid to the relative concentrations of lysozyme, tear lipocalin, secretory IgA (sIgA), IgG and lactoferrin, together with the overall tear electropherogram 'fingerprint'. Furthermore, whilst lens-tear interaction studies are generally thought of as an investigation into the effects of tears components on the contact lens material, i.e. deposition studies, this report addresses the reverse phenomenon--the effect of the lens, and particularly the newly inserted lens, on the tear fluid composition and dynamics. The use of microfluidic technology provides a significant advance in tear studies and should prove invaluable in tear diagnostics and contact lens performance analysis.

Apparent loss of urinary albumin during long-term frozen storage: HPLC vs immunonephelometry

BACKGROUND

Urinary albumin detection by immunonephelometry is decreased by approximately 30% in samples that have been frozen at -20 degrees C. An HPLC method for assessment of urinary albumin that detects immunoreactive and immunochemically nonreactive albumin has been introduced as an alternative to immunonephelometry. We investigated whether this technique is affected by sample temperature, particularly freezing.

METHODS

Urine samples (n = 295) were collected from the general population (Prevention of Renal and Vascular End-Stage Disease Study). Samples were assessed by both immunonephelometry and HPLC when fresh and after storage at -20 degrees C for 4, 8, and 12 months and at -80 degrees C for 12 months.

RESULTS

With immunonephelometry, storage for 4, 8, and 12 months at -20 degrees C resulted in mean (SD) urine albumin changes of -21% (29%), -28% (29%), and -34% (31) (P <0.001 for trend). Storage at -80 degrees C resulted in a 5% (19%) change after 12 months of storage (not significant). With HPLC, storage for 4, 8, and 12 months at -20 degrees C resulted in urine albumin changes of -33% (28%), -43% (24%), and -55% (21%; P <0.001 vs immunonephelometry). Storage at -80 degrees C resulted in a -29% (29%) change (P <0.001 vs immunonephelometry).

CONCLUSION

Loss of albumin after freezing urine depends not only on freezing temperature but also on detection method. Detection of albumin by immunonephelometry appears to be significantly less influenced by freezing than detection by HPLC. Storage at -80 degrees C appears to prevent loss when using immunonephelometry, whereas HPLC still shows considerable loss even when urine is frozen at -80 degrees C. We propose that for reliable measurement of urine albumin, fresh samples should be used.