Urine alpha1-microglobulin is a better marker for early tubular dysfunction than beta2-microglobulin among tenofovir-exposed human immunodeficiency virus-infected men who have sex with men

Objectives: Men who have sex with men are at risk of tenofovir nephrotoxicity due to its wide use in both treatment and prophylaxis for human immunodeficiency virus infection, but little is known about the urinary biomarkers of early renal dysfunction in this population. This study aims to identify useful biomarkers of early renal dysfunction among human immunodeficiency virus-infected men who have sex with men exposed to tenofovir.Methods: In a cross-sectional study urinary alpha1-microglobulin, beta2-microglobulin, N-acetyl-B-n-glucosaminidase and albumin were measured and expressed as the ratio-to-creatinine in 239 human immunodeficiency virus-infected men who have sex with men who were treatment naïve or receiving antiretroviral therapy with tenofovir-containing or non-tenofovir-containing regimens. Additionally, 56 patients in the non-antiretroviral therapy group started a tenofovir-containing regimen and were assessed after 3 and 6 months on antiretroviral therapy.Results: Both the frequency of alpha1-microglobulin proteinuria (alpha1-microglobulin-creatinine ratio >25.8 mg/g) and the median urinary alpha1-microglobulin-creatinine ratio were higher in the tenofovir disoproxil fumarate group than the other two groups (all p< 0.05). A higher frequency of beta2-microglobulin proteinuria (beta2-microglobulin-creatinine ratio >0.68 mg/g) was also observed in the tenofovir group (28.9%) compared to the non-tenofovir group (13.6%, p= 0.024). There were no significant differences between groups for N-acetyl-β-n-glucosaminidase and albumin. In the longitudinal study, the median urinary alphat-microglobulin-creatinine ratio after 3 and 6 months on tenofovir-containing therapy (16.8 and 17.3 mg/g) was higher than baseline (12.3 mg/g, p= 0.023 and 0.011, respectively), while no statistically important changes were observed in urinary beta2-microglobulin-creatinine ratio or in the other biomarkers after 3 and 6 months on antiretroviral therapy (all p> 0.05).Conclusion: Urinary alphat-microglobulin seems to be a more sensitive and stable indicator of tubular dysfunction than urinary beta2-microglobulin for assessing tenofovir-related nephrotoxicity and can be significantly altered after tenofovir exposure.

Urine alpha-1-microglobulin reliability in the diagnosis of pyelonephritis: a systematic review

Introduction:Pyelonephritis is known as kidney inflammation due to bacterial infection which should be diagnosed and treated promptly. In this article, we decided to systematically review the diagnostic value and reliability of evaluating urine excretion low molecular weight protein alpha-1-microglobulin [A1M]

Methods: PubMed and Scopus were searched for the relevant articles about the efficacy of urine alpha-1-micriglobulin assays in the diagnosis of pyelonephritis in children. The search strategy was microglobulin AND pyelonephritis. No language and date limitations were included in this review

Results: A total of 16 articles were retrieved from PubMed and 23 articles from Scopus. After studying the abstracts, only 5 articles were selected, which specifically studied the efficacy of alpha-1-micrglobulin in the diagnosis of pyelonephritis in children

Discussion: A1M is not an acute phase protein but its concentration alters in several clinical conditions

Conclusion: Evaluating the urine concentration of A1M is a noninvasive and cost effective strategy with the diagnostic capability for urinary tract disorders such as early recognition of tubular damages during pyelonephritis

Study of some renal function tests in epileptic children on antiepileptic drug monotherapy

In the present study we tried to verify the renal function status in epileptic children at diagnosis and 4 months following AED monotherapy. This study was carried out on 45 children, 27 males and 18 females aged 5-16 years, suffering from different types of freshly diagnosed epilepsy. They were classified into 3 groups: Group 1: Consisted of 15 patients treated by carbamazepine [CBZ] [Tegretol] monotherapy. Group II: Consisted of 15 patients treated by sodium valproate [VPA] [Depakine] monotherapy. Group Ill: Consisted of 15 patients treated by phenytoin [PHE] [Epanutin] monotherapy. In addition 20 healthy children of matched age and sex, products of nonepileptic families, with normal hepatic and renal function tests, served as a control group. All children included in this study were subjected to the following: determination of fasting blood urea, estimation of fasting serum creatinine, estimation of creatinine clearance, determination of urinary albumin/24 hours, urinary N-acetyl-8-D-glucosaminidase [NAG]/24h and urinary alpha-1 microglobulin [alpha-1MG]/24h. Our results revealed the following: Normal renal glomerular and tubular function tests in patients before therapy. Normal renal glomerular function tests [blood urea nitrogen serum creatinine, creatinine clearance, routine urine analysis and 24 hr urinary albumin] in all patients after AED therapy. Significant increase in urinary NAG was observed in all patient groups after therapy and this increase was highest in patients receiving valproate monotherapy. Significant increases in urinary alpha-1MG in patients receiving carbamazepine or phenytoin with no change following VPA therapy were recorded

Clinical value of urinary alpha 1-microglobulin and N-acetyl beta-D-glucosaminidase in pediatric renal diseases

Measuring urinary alpha[1]-microglobulin [alpha1 MG] and acetyl beta-D-glucosa-minidase [NAG] excretion is widely used as a valuable clinical tool in assessing renal glomerular and tubular lesion in adult, However few data are on values for urinary alpha[1]MG and NAG in pediatrics. The aim of this study was to measure urinary alpha[1]MG and NAG in children in health and diseases and if these might reflect disease activity. We studied 31 children with some clinical renal diseases during active disease and remission over follow-up period of 3 years and 10 healthy children were included as a control group. 10 children with nephritic syndrome [group I], 11 children with nephrotic syndrome [group II] and 10 children with lupus nephritis [group III]. Urinary alpha[1]MG and NAG was measured by radial immunodiffusion technique assay and colorimetric assay respectively. Our results showed significantly higher levels of urinary alpha[1]MG in children with active disease versus controls. The urinary alpha[1]IMG level was in the control [19.67 +/- 8.481, in group 1[53.61 +/- 2.95, p<0.05]. In group 11[91.29 +/- 31.91 p<0.01] in group III [81.27 +/- 15.09, p<0.001] compared to control. Urinary alpha[1] MG level showed no significant difference in patients in remission period versus control [p>0.05]. Urinary level of alpha[1] MG showed significant correlation to proteinuria in group I [r=0.783<0.01] and group 11 [r=0.925, p<0.001] only. On the other hand urinary NAG level showed significantly higher levels in all patients groups [group I, group II, group III], compared to controls [p<0.001] and there was no significant difference in all patients in remission phase compared to controls [p >0, 5]. There was a significant positive correlation between urinary alpha[1]MG and NAG