Value of micro-proteinuria in combination with ultrasonography of the left renal vein in the diagnosis of orthostatic proteinuria.

BACKGROUND: This study aimed to evaluate the clinical value of micro-proteinuria in combination with ultrasonography of the left renal vein (LRV) in the diagnosis of orthostatic proteinuria (OP). METHODS: The patients with suspected OP received West test, upright lordotic position test, Robinson test, ultrasonography of the LRV, and detection of morning urine micro-proteinuria and micro-proteinuria after activity. The sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (PLR and NLR) and Youden's index (YI) for micro-proteinuria, ultrasonography of the LRV and both of them in the diagnosis of OP were analyzed. RESULTS: From January 2013 to January 2018, 75 patients (M/F: 38/37) were recruited. Sixty patients were diagnosed with OP (M/F: 29/31, median age at onset: 10.6±2.80 years); 15 patients had no OP (M/F: 9/6, median age at onset: 10.9±3.25 years); the LRV entrapment, urine Alb/Cr, IgG/Cr, and NAG/Cr after activity were significantly different between OP group and non-OP group (Z=-3.55, -4.10, -4.01, -3.04, P<0.05). The area under the curve (AUC) of urine Alb/Cr, IgG/Cr, NAG/Cr, and the ratio of anteroposterior (AP) for LRV in the hilar and narrow portions (a/b) was 0.84, 0.84, 0.76 and 0.58, respectively, and the best cut-off value was 13.2 mg/mmol, 2.52 mg/mmol, 0.64 U/mmol and 4.06, respectively. The combination of ultrasonography of the LRV and elevated micro-proteinuria after activity could achieve the Se, Sp, PPV, NPV, PLR (weighted by prevalence, W), NLR (W) and YI at 93.3% (95% CI: 0.83-0.98), 66.7% (95% CI: 0.39-0.87), 91.8% (95% CI: 0.81-0.97), 71.4% (95% CI: 0.42-0.90), 11.2 (95% CI: 4.82-26.00), 0.40 (95% CI: 0.17-0.97) and 60%, respectively, in the diagnosis of OP. CONCLUSIONS: The micro-proteinuria in combination of ultrasonography of the LRV is helpful for the preliminary screening of OP in patients with suspected OP.

Microproteinuria Predicts Organ Failure in Patients Presenting with Acute Pancreatitis.

BACKGROUND AND AIMS: The disease course of acute pancreatitis (AP) ranges from mild and self-limiting to severe inflammation, associated with significant morbidity and mortality. At present, there are no universally accepted and reliable predictors for severity. Microproteinuria has been associated with the presence of systemic inflammatory response syndrome as well as trauma, although its association with AP is not well understood. The aim of this study was to investigate the value of microproteinuria to predict development of organ failure in AP. METHODS: Consecutive AP patients were prospectively enrolled. Urine samples were collected upon admission, 12-24 h after admission, and 3 months post-discharge for calculation of urine α1-microglobulin-, albumin-, IgG-, and IgM/creatinine ratios. Data regarding AP etiology, severity, and development of organ failure were registered. RESULTS: Overall, 92 AP patients were included (14 % with organ failure; 6 % with severe AP). The α1-microglobulin-, albumin-, and IgG/creatinine ratios correlated with high-sensitivity C-reactive protein 48 h after admission (r = 0.47-0.61, p < 0.001 for all). They were also significantly higher in patients with versus without organ failure (p < 0.05 for all). The α1-microglobulin/creatinine ratio upon admission predicted organ failure [adjusted odds ratio 1.286, 95 % confidence interval (CI) 1.024-1.614] with similar accuracy (AUROC 0.81, 95 % CI 0.69-0.94) as the more complex APACHE II score (AUROC 0.86, 95 % CI 0.70-1.00). CONCLUSION: The α1-microglobulin/creatinine ratio upon presentation with AP is related to inflammation and predicts development of organ failure. Further studies are warranted to evaluate its potential usefulness in predicting outcome for AP patients.

Urinary microprotein concentrations in the long-term follow-up of dilating vesicoureteral reflux patients who underwent medical or surgical treatment.

PURPOSE: This study examined the relationship between urinary microprotein concentrations and renal functional parameters in children with dilating (grade III-V) vesicoureteral reflux (VUR) who underwent either medical or surgical treatment. METHODS: All 44 dilating VUR patients who were followed for 4 years were screened for inclusion in this study. The patients' clinical features and clinical outcomes, as well as the urinary activities of albumin (ALB), transferrin (TRF), immunoglobulin G (IgG), alpha-1-microglobulin (α1-MG), and N-acetyl-ß-glucosaminidase (NAG), were retrospectively analyzed. RESULTS: High values of NAG, α1-MG, IgG, TRF, and ALB were noted in 73.33, 58.33, 43.33, 24.14, and 53.33 % of patients, respectively, at the first examination. Cystatin C, eGFR, and urinary microprotein levels were associated with a good prognosis after 4 years of follow-up. No differences in recurrent UTI, cystatin C concentration, most microprotein/creatinine (Cr) ratios, eGFR, or ΔGFR4 % were found between the groups. High levels of urinary proteins were found in 2.38-9.52 % of cases after 4 years of follow-up. ALB/Cr, IgG/Cr, and α1-MG/Cr levels were positively correlated with 99mTc-dimercaptosuccinic acid (DMSA) grade, and α1-MG excretion was inversely correlated with eGFR. CONCLUSIONS: The levels of microprotein were elevated at diagnosis in a higher proportion of patients than for the other markers examined. At long-term follow-up, the reflux level had decreased or completely resolved in all patients, and the proportions of microproteins that were elevated were significantly reduced. Renal impairment measured by eGFR and DMSA grade was related to increased urinary α1-MG levels.

Bianalyte multicommutated flow analysis system for microproteinuria diagnostics.

In this work a bianalyte multicommutated flow analysis (MCFA) system for determination of microproteinuria is presented. The developed MCFA system is based on two dedicated optoelectronic flow-through detectors which allow estimation of urinary protein creatinine ratio. For total protein determination, turbidimetric Exton's method was used, whereas creatinine was determined by the photometric Jaffe reaction. The developed analytical system is fully-mechanized, easy to operate, economic in reagent consumption and characterized by satisfactory analytical parameters. It allows protein determination in the range 36-300 mg L(-1) with 33 mg L(-1) detection limit and simultaneous determination of creatinine in the range 0.045-2.50 mmol L(-1) with 0.025 mmol L(-1) detection limit. The measurement procedure for the presented MCFA system offers performing 30 peaks per hour for both analytes. To prove the analytical usefulness of the system, real human urine samples have been analyzed. The correlation and agreement between results offered by the developed system and clinical analyzers are fully acceptable.

The clinical significance of microproteinuria and the correlation between microproteinuria and renal pathological changes in patients with systemic lupus erythematosus / 中华风湿病学杂志

Objective To explore the clinical significance of urinary ?1-microglobulin (?1-MG), ?2-micro-globulin (?2-MG), albumin (MA), immunoglobulin G (IGU) and transferritin (TRU), and investigate the correlation between microproteinuria and renal pathological changes in patients with systemic lupus erythematosus (SLE). Methods According to the presence of nephritis, 47 SLE patients who had renal biopsy were divided into two groups: 30 patients with clinical lupus nephritis (OLN), and 17 patient with silent lupus nephritis (SLN). The urinary ?1-MG, ?2-MG, MA, IGU and TRU were measured in SLE patients and compared with healthy control group. The level of microproteinuria and renal biopsy pathological changes in SLE patients were studied. Results ①The levels of urinary ?1-MG, ?2-MG, MA, IGU and TRU had statistical differences between SLE group and healthy control group, OLN group and SLN group, SLN group and healthy control group respectively. ②The levels of urinary MA、TRU、 IGU were significantly higher in WHO class Ⅳ than in class Ⅱ LN, the level of urinary MA was markedly increased in class Ⅳ than in class Ⅲ LN and ?1-MG was significantly different between class Ⅳ and Ⅴ LN. In classⅤ LN, the urinary MA was obviously increased compared with class Ⅱ LN. Conclusion ①The urinary ?1-MG, ?2-MG, MA, IGU and TRU reflects the severity of renal damage in SLE patients and may be used as sensitive markers for early lupus nephritis. ②The measurement of microproteinuria indicates that the difference in severity of renal damage exists among different WHO classes of LN and urinary MA and ?1-MG may be sensitive indicators.

The effect of elastase on microproteinuria in NIDDM / 中国糖尿病杂志

To investigate the effect of pancreatic elastase on diabetic nephropathy,104 cases of type Ⅱ diabetic patients were selected as control group and group treated with elastase separately for a course of 6 months.The results showed that pancreatic elastase reduced microproteinuria significantly,especially mi- croalbuminuria and microtransfer rrinuria which reflect the glomerular filtration rate.It was concluded that elastase could improve early diabetic nephropathy and might have some protective effect as well.At the same time,elastase had some good effect on lipid and lipoprotein metabolism.