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Objective To investigate the value of urinary α1-microglobulin (α1-MG) and N-acetyl-β-D-glucosaminidase/urinary creatinine (NAG/UCr) in monitoring renal injury in patients with chronic hepatitis B virus (HBV)-related liver diseases. Methods A total of 85 patients with HBV-related liver diseases who attended The Second Affiliated Hospital of Kunming Medical University from August 2019 to August 2020 were enrolled, and according to the history of treatment with nucleos(t)ide analogues (NUC), they were divided into NUC treatment group with 57 patients and non-NUC treatment group with 28 patients; according to the type of NUC used, the NUC treatment group was further divided into entecavir (ETV) treatment group with 32 patients and tenofovir disoproxil fumarate (TDF) treatment group with 25 patients; according to the results of HBV serum antigen and antibody markers, the patients were divided into HBeAg-negative group with 57 patients and HBeAg-positive group with 28 patients; according to the results of serum HBV DNA quantification, the patients were divided into HBV DNA-negative group with 47 patients and HBV DNA-positive group with 38 patients; according to abdominal imaging findings, the patients were divided into non-liver cirrhosis group with 47 patients and liver cirrhosis group with 38 patients. The data on medical history and laboratory markers were collected for comparison between two groups. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of data with skewed distribution between two groups; the chi-square test was used for comparison of categorical data between two groups. The McNemar test was used to compare the diagnostic merit of each index; a Spearman correlation analysis was used to investigate the correlation of each factor with α1-MG, and NAG/UCr; the multiple linear regression analysis was used to analyze the independent influencing factors for α1-MG and NAG/UCr. Results The non-NUC treatment group, the HBeAg-positive group, and the HBV DNA-positive group had significantly higher levels of urinary α1-MG than the NUC treatment group ( Z =-2.054, P =0.04), the HBeAg-negative group ( Z =-2.293, P =0.022), and the HBV DNA-negative group ( Z =-2.229, P =0.026), respectively. The HBV DNA-positive group and the liver cirrhosis group had significantly higher levels of NAG and NAG/UCr than the HBV DNA-negative group ( Z =-2.908 and -2.824, both P < 0.05) and the non-liver cirrhosis group ( Z =-3.204 and -3.412, both P < 0.05), respectively. There was a significant difference in the proportion of patients with abnormal α1-MG and that of patients with abnormal estimated glomerular filtration rate (eGFR) (31.8% vs 20.0%, χ 2 =7.178, P =0.007), and the proportion of patients with abnormal α1-MG and NAG/UCr was significantly higher than that of patients with abnormal eGFR (35.3% vs 20.0%, χ 2 =8.049, P =0.005). There was a significant difference in diagnostic merit between α1-MG+NAG/UCr and eGFR ( P =0.015). Age ( β =0.246, P < 0.05), positive HBeAg ( β =0.284, P < 0.01), and liver cancer ( β =0.291, P < 0.01) were independent risk factors for the increase in α1-MG, while the increase in FIB-4 value ( β =0.352, P < 0.05), ascites ( β =0.260, P < 0.05), esophagogastric varices( β =-0.248, P < 0.05), positive HBV DNA ( β =0.197, P < 0.05), and high total bilirubin ( β =0.257, P < 0.05) were independent risk factors for the increase in NAG/UCr. Conclusion In patients with chronic HBV-related liver diseases, renal injury may occur during the whole course of active viral replication, liver cirrhosis, and deterioration of liver function. Antiviral therapy with NUC can alleviate renal impairment caused by HBV and is safe and reliable within a certain course of treatment. Combined measurement of urinary α1-MG and NAG/UCr has more advantages over eGFR in the diagnosis of early renal injury, and it is an effective method for renal function monitoring in patients with chronic HBV-related liver diseases.
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Background: Diabetic nephropathy is a major cause of premature morbidity and mortality in type 1 and type 2 diabetes mellitus (T2DM) and hence new markers with better sensitivities are being investigated. The study was taken up to investigate whether urinary activities of N-acetyl-β-D-glycosaminidase (NAG), alkaline phosphatase (ALP), lactate dehydrogenase LDH) and Gamma glutamyl transferase (γ-GT) can be used as screening markers of renal dysfunction in patients suffering from T2DM.Methods: One hundred and four patients with T2DM along with 30 age- and gender-matched healthy individuals were included in the study. Patients were divided into three groups based on their u-MA levels i.e. normoalbuminuric (group1), micro albuminuric (group 2) and macroalbuminuric (group 3).Results: Urinary enzymes activity was significantly higher in patients with T2DM compared to controls (p<0.05). NAG, ALP, LDH, and GGT were significantly higher in group 3 compared to group1 and group 2 (p<0.0001). NAG, ALP, LDH and GGT showed significant positive correlation with MA (p=0.0001, r=0.308; p=0.0001, r=0.369; p=0.002, r=0.304, p=0.044, r=0.202 respectively). GGT and LDH showed highest sensitivity (86.21%, 84.00% respectively) and specificity (78.57%,53.49% respectively) for diagnosing renal dysfunction in patients with normoalbuminuria.Conclusions: The study suggests that u-GGT and LDH can be useful markers for assessing renal dysfunction in T2DM patients even before microalbuminuria manifests.
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Objective To explore the effects of hawthorn proanthocyanidins (HPC) and vitamin C (VC) on kidney protection in insulin-resistance (IR) rats. Methods The IR rats were induced by high-fat diet in order to establish the model of nephropathy in type II diabetic rats, and the high-fat feeding were continued for 2 weeks after the IR rats were made. The contents of fasting blood glucose, serum insulin, glucose and microabuminuria (mAlb) in urine were tested. Fifty IR model rats were divided into model, HPC (56 mg/kg), VC (180 mg/kg), combined application of HPC (56 mg/kg) and VC (180 mg/kg), and rosiglitazone (2 mg/kg) groups. Another 10 normal rats were selected randomly to be control group. After continuous ig administration for 20 weeks in each group, these indexs, such as the levels of fasting blood glucose (FBG), serum insulin (SI), glucose in urine (24 h), creatinine (Cr), urea nitrongen (UN), uric acid (UA), were all detected. The excretion of urinary total protein (UTP), microabuminuria (mAlb), N-acetyl-β-D-glucosaminidase (NAG) were also measured. Moreover, the histopathological microstructure of kidney was observed by light microscope. Results After modeling, the levels of FBG, SI and glucose in urine increased significantly (P < 0.01) in comparation with the control group, so does the levels of UN, Cr, UA (P < 0.01) and the excretion rates of UTP, mAlb, NAG (P < 0.01). However, all these indexs were decreased significantly (P < 0.01) after the combined use of HPC and VC, which were more notable than that in HPC and VC group (P < 0.01) and equivalent to that in rosiglitazone group. Conclusion The combined application of HPC and VC can improve the renal function of IR rats and have protective effects on kidney injury.
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ObjectiveTo investigate the effect ofHuayu-Niaoshidecoction on renal injury in the patients with kidney stones after extra corporeal lithotripsy (ESWL). MethodsAccording to the inclusion criteria, 120 patients diagnosed with kidney stones were randomly divided into 2 groups with the random number table method, 60 patients in each group. Both groups were treated with double pulse extracorporeal shock wave lithotripsy (ESWL). Based on the ESWL, the control group was added with levofloxacin mesylate tablets for 3 days with the start of the day of the gravel; and the treatment group was treated withHuayu-Niaoshi decoction for 14 days based on the treatment of control group. The levels of serum endothelial endothelin 1 (ET-1), malondialdehyde (MDA), urinary N-acetyl-β-Dglucosaminidase (NAG) N-acetyl-beta-d Glucosaminidase and urine beta 2 microspheres protein (beta eukaryotic 2-mg) were detected at time of gravel, 2 hours after gravel and 2 weeks after gravel. ResultsAfter 2 weeks treatment, the levels of urinary NAG (7.33 ± 4.39 U/L vs. 9.93 ± 5.10 U/L;Z=2.587,P=0.002), serum MDA (4.63 ± 0.90 nmol/mlvs. 7.29 ± 2.16 nmol/ml;Z=5.520, P=0.001), serum ET-1 (35.06 ± 10.51 pg/mlvs. 46.90 ± 18.74 pg/ml;Z=3.315,P=0.001) and urineβ2-MG (0.14 ± 0.19) mg/Lvs. 0.19 ± 0.19 mg/L;Z=1.759,P=0.079) in the treatment group were significantly lower than those in the control group. Conclusions TheHuayu-Niaoshidecoction can improve renal injury in the patients with kidney stones after extra corporeal lithotripsy.
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Concentrations of heavy metals exceed safety thresholds in the soil near Janghang Copper Refinery, a smelter in Korea that operated from 1936 to 1989. This study was conducted to evaluate the level of exposure to toxic metals and the potential effect on health in people living near the smelter. The study included 572 adults living within 4 km of the smelter and compared them with 413 controls group of people living similar lifestyles in a rural area approximately 15 km from the smelter. Urinary arsenic (As) level did not decrease according to the distance from the smelter, regardless of gender and working history in smelters and mines. However, in subjects who had no occupational exposure to toxic metals, blood lead (Pb) and cadmium (Cd) and urinary Cd decreased according to the distance from the smelter, both in men and women. Additionally, the distance from the smelter was a determinant factor for a decrease of As, Pb, and Cd in multiple regression models, respectively. On the other hands, urinary Cd was a risk factor for renal tubular dysfunction in populations living near the smelter. These results suggest that Janghang copper smelter was a main contamination source of As, Pb, and Cd, and populations living near the smelter suffered some adverse health effects as a consequence. The local population should be advised to make efforts to reduce exposure to environmental contaminants, in order to minimize potential health effects, and to pay close attention to any health problems possibly related to toxic metal exposure.
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Adult , Aged , Female , Humans , Male , Middle Aged , Acetylglucosaminidase/urine , Arsenic/urine , Bone Density , Cadmium/blood , Case-Control Studies , Chemical Industry , Creatinine/urine , Environmental Exposure , Environmental Pollutants/analysis , Lead/blood , Regression Analysis , Republic of Korea , Spectrophotometry, AtomicABSTRACT
Objective To explore the differences of biological markers level between upper urinary tract infection(UUTI) and lower urinary tract infection(LUTI) in children for providing help for localization diagnosis of urinary tract infection(UTI).Methods One hundred and nine children with UTI hospitalized in Children's Hospital of Tianjin from May 2010 to Jan.2012 were divided into UUTI group (18 cases) and LUTI group (91 cases).The clinical information (sex,age,onset symptoms),laboratory test including blood urea nitrogen and creatinine,biological markers including serum cystatin C(CysC),procalcitonin(PCT),β2-microglobulin (β2-MG),urine microalbumin(mAlb),transferrin (TF),α1-microglobulin (α1-MG),β2-MG and N-acetyl-β-D-glucosaminidase (NAG) were recorded.Then SPSS 17.0 software was used to analyze the data.Results UUTI children showed higher level of serum CysC,PCT,urine mAlb,TF,α1-MG,β2-MG and NAG than LUTI children did.The area under ROC curve of the 7 biological markers were all between 0.71 and 0.87.Logistic regression test was used to do multiple regression analysis and establish the multiple regression model.The standard of eliminating or screening variables was 0.05.CysC,PCT,NAG were identified as influence factors.Combining test result of CysC,PCT,NAG could improve diagnostic value so that the sensitivity could reach 90％ and the specificity could reach 88.9％.Conclusions Both of serum CysC,PCT and urine mAlb,TF,α1-MG,β2-MG,NAG can be used for the positioning diagnosis of UTI,and the diagnostic value of joint test of serum change of CysC,PCT,urine NAG is higher than any single biological marker.
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Objective To compare the efficacy of urinary type Ⅳ collagen( Ⅳ C), N-acetyl-β-D-glucosaminidase( NAG ), serum cystatin C ( CysC ), β2 microglobulin ( β2-MG ) in early diagnosis of diabetic nephropathy(DN) ,and to develop a multiple regression equation using above mentioned indices. Methods One hundred and eight cases of DM patients were enrolled in the study. All those DM patients were divided into two groups according to 24 hr urinary albumin excretion(UAE): non-DN group( UAE ＜30 mg/24 h)and DN group (UAE ≥30 mg/24 h). Receiver operating characteristics (ROC)curve was developed using urinary IVC, NAG,serum CysC and β2-MG,and the efficiency of the four indices for early diagnosis of diabetic nephropathy were assessed by area under the curve ROC (AUCROC). Furthermore, the regression equation of four indicators was developed. All statistical analyses were performed using SPSS 13.0. Results The levels of urine Ⅳ C, NAG,CysC,β2-MG,were(3.91±1.93)ng/ml, ( 12.20 ±3.46)U/L, ( 1.18 ±0.41 )mg/L , (2. 50 ±0. 74)mg/ml in the non-DN group, respectively; and ( 14.14 ± 11.17 ) ng/ml, ( 23.12 ± 13.57 ) U/L, ( 2.69 ± 1.69 ) mg/L and(5.21 ± 2.78)mg/ml in the DN group, respectively. There were significant differences in the comparison of the four indicators between the two groups ( Ps ＜ 0.01 ). AUCROC of Ⅳ C, NAG, CysC and β2-MG were 0. 747,0.732,0.764 and 0.823 respectively;which meant the diagnostic efficacy for DN decended from β2-MG, CysC,Ⅳ C, to NAG in order. All these indices showed significant efficiency in assisting diagnosis of early DN ( Ps ＜0.01 ). The regression equation of UAE and the four indices was: UAE = - 242.624 + 6.362IVC + 8.662NAG + 64. 622CysC + 29.488β2-MG, and the equation had statisticl significance( P ＜ 0.O1 ). Conclusion Urine Ⅳ C, NAG,serum CysC, and β2-MG showed significant value in assisting diagosis of early DN, and could be sensitive indices for DN.
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Objective To prospectively study the difference of urinary N-acetyl-β-D-glucosaminidase( UN-AG) and retinol binding protein(URBP) in contrast-induced nephropathy (CIN). Methods The clinical data of 150 patients undergoing coronary angiography were documented. The urine and blood samples before,24 hours after and 48～72 hours after the procedure were collected;Serum creatinine (SCr) and urinary ereatinine (UCr)were tested by enzymic method. UNAG and URBP were tested by ELISA in CIN and control group. CIN was defined as an increase in SCr of ≥44 μmol/L or >25% from baseline 48 ～72 h after the procedure. 27 age- , sex- , results of coro-nary angiography-matched cases were taken as control group. Results CIN was diagnosed in 13 of 150 patients (8.7%). In CIN group, UNAG/UCr were significantly higher than that in control group[ 1.97 (1.06,2.64) U/mmol vs 1.07 (0, 68,1.88 ) U/mmol, Z = 2.076, P = 0.039 ] before ;24 hours after the procedure, UNAG/UCr was signifi-cantly up-regulated in CIN group from baseline level [ 2.82 ( 1.88 ,4.26) U/mmol vs 1.97 (1.06,2.64) U/mmol, Z =2.607,P =0. 009]. ROC curve analysis showed that baseline UNAG could be used as an early predictor for CIN, the AUC =0. 776 ,P =0.023 ;when cut off value = 8.08 U/L,the sensitivity and specificity of UNAG were 0. 771 and 0. 713 respectively. The percentage of patients of UNAG over 8.08 U/L in CIN group was significantly higher than that in control group[77.1% (10/13) vs 29.6% (8/27) ,Z =2. 564,P =0. 011 ] ,the related risk factor is 5.58,95% CI was 1.24 ～ 25.08. Conclusion UNAG could be used as a predictor of CIN before the procedure and its postprocedure 24 h level maybe useful in early diagnosis after the procedure.