D'Amico Giuseppe, Bazzi Claudio
Division of Nephrology, San Carlo Borromeo Hospital, Milan, Italy.
Curr Opin Nephrol Hypertens. 2003 Nov;12(6):639-43. doi: 10.1097/01.mnh.0000098771.18213.a6.
In this review we intend to evaluate the clinical usefulness of measurement of urinary excretion of microproteins and tubular enzymes.
Studies of patients with acute tubular necrosis showed that the excretion of some well known enzymes and of new markers such as kidney injury molecule-1 has higher value than classic renal function tests for the early detection of the disease as well as for the prediction of the development of overt acute renal failure. Tubular dysfunction may be detected by measurement of the excretion of tubular enzymes and microproteins not only in workers chronically exposed to heavy metals but also in population exposed to low environmental level below the limits set by the WHO. In chronic glomerulonephritis the excretion of alpha1-microglobulin is significantly associated with the extent of tubulo-interstitial damage and predicts outcome better than proteinuria/day; in the same diseases NAG excretion is significantly dependent on immunoglobulin G and alpha1-microglobulin excretion and predicts remission, progression and response to therapy.
The measurement of urinary excretion of tubular enzymes and microproteins may be clinically useful in several different kidney diseases (such as acute tubular necrosis, glomerulonephritis) both for diagnosis and prediction of fractional outcome.
在本综述中，我们旨在评估测定尿中微蛋白和肾小管酶排泄量的临床实用性。
对急性肾小管坏死患者的研究表明，一些知名酶以及诸如肾损伤分子-1等新标志物的排泄量，在疾病早期检测以及预测明显急性肾衰竭的发生方面，比传统肾功能测试具有更高的价值。不仅在长期接触重金属的工人中，而且在接触低于世界卫生组织设定限值的低环境水平的人群中，通过测定肾小管酶和微蛋白的排泄量都可以检测到肾小管功能障碍。在慢性肾小球肾炎中，α1-微球蛋白的排泄量与肾小管间质损伤程度显著相关，并且比每日蛋白尿更好地预测预后；在同一疾病中，NAG排泄量显著依赖于免疫球蛋白G和α1-微球蛋白排泄量，并可预测缓解、进展及对治疗的反应。
测定肾小管酶和微蛋白的尿排泄量在几种不同的肾脏疾病（如急性肾小管坏死、肾小球肾炎）的诊断和预测部分预后方面可能具有临床实用性。
