Müller D, Greve D, Eggert P
University of Nijmegen, The Netherlands.
Pediatr Nephrol. 2000 Nov;15(1-2):85-9. doi: 10.1007/s004670000403.
The prognosis of Henoch-Schonlein purpura (HSP) is mainly determined by the involvement of the kidney, but prognostic markers have not been established. To study the extent of tubular involvement in HSP and its relationship to the development of HSP nephritis, we measured the urinary excretion of two tubular marker proteins in 36 children with HSP. After admission, urinary N-acetyl-beta-D-glucosaminidase (NAG) was determined in 20 children and alpha1-microglobulin (alpha1-MG) in 16 children respectively. These values were compared with the biochemical data on admission, 1 month, 6 months, and 12 months later. A total of 198 24-h urine samples from healthy children were used for the establishment of reference data for NAG and alpha1-MG (mean+/-2 SD). Twenty-one patients had elevated excretion of either NAG (>mean+2 SD, n=12) or alpha1-MG (>mean+2 SD, n=9). The highest values (>mean+4 SD) were found in patients with early kidney involvement. Normal values were accompanied by a benign further clinical course. Children with intermediate high values (>mean+2 SD, <mean+4 SD) developed signs of renal involvement during follow-up. Hence, tubular proteinuria is common during the early stages of HSP. NAG and alpha1-MG levels correlate well with the extent of early and late renal involvement. Tubular marker proteins may be prognostic markers for the development of HSP nephritis.
过敏性紫癜（HSP）的预后主要取决于肾脏受累情况，但尚未确立预后标志物。为了研究HSP肾小管受累程度及其与HSP肾炎发生的关系，我们测定了36例HSP患儿两种肾小管标志物蛋白的尿排泄量。入院后，分别测定了20例患儿的尿N - 乙酰 - β - D - 氨基葡萄糖苷酶（NAG）和16例患儿的α1 - 微球蛋白（α1 - MG）。将这些值与入院时、1个月、6个月和12个月后的生化数据进行比较。共收集了198份健康儿童的24小时尿样用于建立NAG和α1 - MG的参考数据（均值±2标准差）。21例患者的NAG（>均值 + 2标准差，n = 12）或α1 - MG（>均值 + 2标准差，n = 9）排泄量升高。早期肾脏受累患者的值最高（>均值 + 4标准差）。正常值伴随良性的进一步临床病程。中度高值（>均值 + 2标准差，<均值 + 4标准差）的儿童在随访期间出现肾脏受累迹象。因此，肾小管蛋白尿在HSP早期很常见。NAG和α1 - MG水平与早期和晚期肾脏受累程度密切相关。肾小管标志物蛋白可能是HSP肾炎发生的预后标志物。
