Proletov Ia Iu, Saganova E S, Galkina O V, Zubina I M, Bogdanova E O, Sipovskiĭ V G, Smirnov A V
Ter Arkh. 2013;85(6):10-6.
To study an association between clinical and morphological evidence and the serum and daily urinary levels of cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL) in patients with primary glomerulopathies.
The investigation included 104 patients; morphological examination showed minimal change disease in 15 (14.4%) patients, focal segmental glomerulosclerosis in 24 (23.1%), membrane nephropathy in 32 (30.8%), and IgA nephropathy (mesangioproliferative glomerulonephritis) in 33 (31.7%). The investigators analyzed the clinical type of nephropathy, performed conventional laboratory and instrumental examinations, and determined the level of CysC (by immunoturbodimetry) and NGAL (by enzyme immunoassay) in the serum and daily urine taken before kidney biopsy. The degree of glomerulosclerosis, tubulointerstititial sclerosis, and tubular atrophy was semiquantitatively estimated.
Urinary CysC and NGAL excretion correlated with the degree of glomerulosclerosis and proteinuria and the reduced glomerular filtration rate (GFR) regardless of the method of its determination. The urinary level of NGAL positively correlated with the degree of tubular atrophy. The GFR value determined from serum CysC and creatinine levels more precisely reflected the degree of glomerulosclerosis.
The tubulointerstitial compartment in primary glomerulopathies should be determined not only by morphological changes, but also by tubular function parameters by estimating the urinary excretion of biomarkers. The urinary content of CysC reflects tubular epithelial dysfunction whereas that of NGAL also characterizes tubular atrophy. To estimate the degree of glomerulosclerosis, it is more preferable to use the GFR calculated from the blood concentrations of CysC and creatinine, by keeping in mind clinical findings (using Chronic Kidney Disease Epidemiology Collaboration formula, 2012).
研究原发性肾小球疾病患者的临床及形态学证据与胱抑素C（CysC）和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）的血清及每日尿水平之间的关联。
该研究纳入104例患者；形态学检查显示，15例（14.4%）患者为微小病变性肾病，24例（23.1%）为局灶节段性肾小球硬化，32例（30.8%）为膜性肾病，33例（31.7%）为IgA肾病（系膜增生性肾小球肾炎）。研究者分析了肾病的临床类型，进行了常规实验室及仪器检查，并测定了肾活检前采集的血清及每日尿液中CysC（采用免疫比浊法）和NGAL（采用酶免疫法）的水平。对肾小球硬化、肾小管间质硬化及肾小管萎缩的程度进行了半定量评估。
无论采用何种测定方法，尿CysC和NGAL排泄均与肾小球硬化程度、蛋白尿及肾小球滤过率（GFR）降低相关。尿NGAL水平与肾小管萎缩程度呈正相关。根据血清CysC和肌酐水平测定的GFR值更准确地反映了肾小球硬化程度。
原发性肾小球疾病中的肾小管间质部分不仅应通过形态学改变来确定，还应通过评估生物标志物的尿排泄情况，依据肾小管功能参数来确定。CysC的尿含量反映肾小管上皮功能障碍，而NGAL的尿含量也可表征肾小管萎缩。为评估肾小球硬化程度，更宜采用根据CysC和肌酐血浓度计算的GFR，并结合临床 findings（采用慢性肾脏病流行病学协作组公式，2012）。
