Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Department of Pediatrics, Fussa Hospital, Tokyo, Japan.
Pediatr Nephrol. 2023 Feb;38(2):479-487. doi: 10.1007/s00467-022-05577-3. Epub 2022 May 19.
The leading cause of advanced chronic kidney disease (CKD) in children is congenital anomalies of the kidney and urinary tract (CAKUT). However, the most appropriate parameters of biochemical urine analysis for detecting CAKUT with kidney dysfunction are not known.
The present observational study analyzed data on children with CAKUT (stage 2-4 CKD) and the general pediatric population obtained from school urine screenings. The sensitivity and specificity of urine alpha 1-microglobulin-, beta 2-microglobulin-, protein-, and the albumin-to-creatinine ratios (AMCR, BMCR, PCR, ACR, respectively) in detecting CAKUT with kidney dysfunction were compared with those of the conventional urine dipstick, and the most appropriate of these four parameters were evaluated.
In total, 77 children with CAKUT and 1712 subjects in the general pediatric population fulfilled the eligibility criteria. Conventional dipstick urinalysis was insufficient due to its low sensitivity; even when the threshold of proteinuria was +/-, its sensitivity was only 29.7% for stage 2 and 44.1% for stage 3 CKD. Among the four parameters assessed, the AMCR and BMCR were adequate for detecting CAKUT in children with stage 3-4 CKD (the respective sensitivity and specificity of the AMCR for detecting CAKUT in stage 3 CKD was 79.4% and 97.5% while that of BMCR was 82.4% and 97.5%). These data were validated using national cohort data.
AMCR and BMCR are superior to dipstick urinalysis, PCR, and ACR in detecting CAKUT with kidney dysfunction, particularly stage 3 CKD. However, for AMCR, external validation is required. A higher resolution version of the Graphical abstract is available as Supplementary information.
儿童晚期慢性肾脏病（CKD）的主要病因是肾脏和泌尿道先天畸形（CAKUT）。然而，用于检测有肾功能障碍的 CAKUT 的最佳生化尿液分析参数尚不清楚。
本观察性研究分析了来自学校尿液筛查的 CAKUT（CKD 2-4 期）患儿和一般儿科人群的数据。比较了尿α 1-微球蛋白、β 2-微球蛋白、蛋白和白蛋白/肌酐比值（AMCR、BMCR、PCR、ACR）在检测有肾功能障碍的 CAKUT 时的敏感性和特异性，评估了这四个参数中最合适的参数。
共有 77 例 CAKUT 患儿和 1712 例一般儿科人群符合入选标准。常规尿试纸法由于敏感性低而不充分；即使蛋白尿的阈值为“+/-”，其对 2 期和 3 期 CKD 的敏感性也仅分别为 29.7%和 44.1%。在评估的四个参数中，AMCR 和 BMCR 足以检测 3-4 期 CKD 患儿的 CAKUT（AMCR 检测 3 期 CKD 的 CAKUT 的敏感性和特异性分别为 79.4%和 97.5%，而 BMCR 为 82.4%和 97.5%）。这些数据使用国家队列数据进行了验证。
AMCR 和 BMCR 优于尿试纸法、PCR 和 ACR，可用于检测有肾功能障碍的 CAKUT，特别是 3 期 CKD。然而，AMCR 需要外部验证。图形摘要的更高分辨率版本可作为补充信息提供。
