Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Clin J Am Soc Nephrol. 2013 Jul;8(7):1106-14. doi: 10.2215/CJN.04510512. Epub 2013 Mar 28.
Albuminuria is associated with risk for renal and cardiovascular disease. It is difficult to predict which persons will progress in albuminuria. This study investigated whether assessment of urinary markers associated with damage to different parts of the nephron may help identify individuals that will progress in albuminuria.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Individuals were selected from a prospective community-based cohort study with serial follow-up and defined as "progressors" if they belonged to the quintile of participants with the most rapid annual increase in albuminuria, and reached an albuminuria ≥150 mg/d during follow-up. Patients with known renal disease or macroalbuminuria at baseline were excluded. Each progressor was matched to two control participants, based on baseline albuminuria, age, and sex. Furthermore, damage markers were measured in a separate set of healthy individuals.
After a median follow-up of 8.6 years, 183 of 8394 participants met the criteria for progressive albuminuria. Baseline clinical characteristics were comparable between progressors and matched controls (n=366). Both had higher baseline albuminuria than the overall population. Urinary excretion of the glomerular damage marker IgG was significantly higher in progressors, whereas urinary excretion of proximal tubular damage markers and inflammatory markers was lower in these individuals compared with controls. Healthy individuals (n=109) had the lowest values for all urinary damage markers measured.
These data suggest that albuminuria associated with markers of glomerular damage is more likely to progress, whereas albuminuria associated with markers of tubulointerstitial damage is more likely to remain stable.
蛋白尿与肾脏和心血管疾病风险相关。难以预测哪些人会出现蛋白尿进展。本研究旨在探究评估与肾脏不同部位损伤相关的尿标志物是否有助于识别可能出现蛋白尿进展的个体。
设计、设置、参与者和测量：从一项具有连续随访的前瞻性社区为基础的队列研究中选择个体，若其属于白蛋白尿年增长率最快的五分位数参与者，且在随访期间达到白蛋白尿≥150mg/d，则将其定义为“进展者”。排除基线时患有已知肾脏疾病或大量白蛋白尿的患者。根据基线白蛋白尿、年龄和性别，每位进展者匹配两个对照参与者。此外，还在一组健康个体中测量了损伤标志物。
中位随访 8.6 年后，8394 名参与者中有 183 名符合进行性白蛋白尿标准。进展者和匹配对照者的基线临床特征（n=366）相似，两组的基线白蛋白尿均高于总体人群。进展者的肾小球损伤标志物 IgG 的尿排泄量明显更高，而这些个体的近端肾小管损伤标志物和炎症标志物的尿排泄量则低于对照组。测量的所有尿损伤标志物中，健康个体（n=109）的值最低。
这些数据表明，与肾小球损伤标志物相关的白蛋白尿更可能进展，而与肾小管间质损伤标志物相关的白蛋白尿更可能保持稳定。
