Brovko M Yu, Pulin A A, Kustova T Yu, Sholomova V I, Loshkareva O A, Taranova M V, Kozlovskaya L V
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
Ter Arkh. 2016;88(6):51-57. doi: 10.17116/terarkh201688651-57.
To estimate the urinary excretion of KIM-1 in groups of patients with varying clinical activity of chronic glomerulonephritis (CGN) and to determine the possibility of using the urinary KIM-1 concentration as a criterion for predicting the course of CGN.
A total of 47 patients with CGN were examined. Group 1 included 10 patients with nephrotic syndrome (NS) and decreased glomerular filtration rate (GFR); Group 2 consisted of 16 patients with NS and normal GFR; Group 3 comprised 10 patients with partial remission of NS; Group 4 included 11 patients with CGN, hematuria, moderate proteinuria, and normal GFR. A control group consisted of 9 healthy individuals. In the examined groups, urinary KIM-1 concentrations were estimated using an indirect immunoassay.
The urinary KIM-1 excretion in the patients with CGN was higher than that in the healthy individuals (p <0.0001), at the same time, in the average the KIM-1 excretion was statistically significantly higher in the patients with proteinuria than in those with hematuria (p=0.01). The highest levels were registered in Group 1; Group 2 was intermediate in the level of KIM-1 excretion and the difference between Groups 3 and 4 proved to be statistically insignificant. The lowest levels were noted in Group 4 and in the controls; the differences between the groups were statistically insignificant. In the patients with CGN, the level of KIM-1 excretion was established to correlate with all indicators of NS severity. The value of the determination of KIM-1 as a risk factor of persistent/refractory NS was estimated. The results of constructing the ROC-curve indicate that KIM-1 levels higher than 2.34 ng/ml could predict NS persistence in CGN patients with a high sensitivity and specificity.
Urinary KIM-1 levels may be used to estimate the activity of CGN with NS and to evaluate the efficiency of treatment. The results of the study substantiate the search for ways of pharmacological blockade of KIM-1 production in the kidney in order to optimize the methods that impact on the pathogenesis of CGN progression.
评估不同临床活动度的慢性肾小球肾炎（CGN）患者尿中肾损伤分子-1（KIM-1）的排泄情况，并确定尿KIM-1浓度作为预测CGN病程标准的可能性。
共检查了47例CGN患者。第1组包括10例肾病综合征（NS）且肾小球滤过率（GFR）降低的患者；第2组由16例NS且GFR正常的患者组成；第3组包含10例NS部分缓解的患者；第4组包括11例CGN、血尿、中度蛋白尿且GFR正常的患者。对照组由9名健康个体组成。在所检查的各组中，采用间接免疫测定法评估尿KIM-1浓度。
CGN患者尿KIM-1排泄高于健康个体（p<0.0001），同时，蛋白尿患者的KIM-1排泄平均在统计学上显著高于血尿患者（p=0.01）。第1组的水平最高；第2组KIM-1排泄水平居中，第3组和第4组之间的差异经统计学检验无显著意义。第4组和对照组的水平最低；各组之间的差异无统计学意义。在CGN患者中，KIM-1排泄水平与NS严重程度的所有指标均相关。评估了将KIM-1测定作为持续性/难治性NS危险因素的价值。构建ROC曲线的结果表明，KIM-1水平高于2.34 ng/ml可高灵敏度和特异性地预测CGN患者的NS持续性。
尿KIM-1水平可用于评估合并NS的CGN的活动度及治疗效果。该研究结果支持探索肾脏中KIM-1产生的药理学阻断方法，以优化影响CGN进展发病机制的方法。
