Sesso R, Rettori R, Nishida S, Sato E, Ajzen H, Pereira A B
Department of Medicine, Escola Paulista de Medicina, Sao Paulo, Brazil.
Nephrol Dial Transplant. 1994;9(4):367-71.
We evaluated the presence of proximal renal tubular dysfunction as measured by urinary retinol-binding protein (RBP) in 70 patients with systemic lupus erythematosus. Renal disease activity was assessed using the British Isles Lupus Assessment Group (BILAG) index. This is a clinical-laboratory score based on the principle of the physician's intention to treat. Increased urinary RBP (> 400 micrograms/l) was detected in 17 of 22 (77%) patients with active nephritis, six of 18 (33%) patients with probably active nephritis, one of nine (12%) cases with stable renal disease, and one of 21 (5%) cases without apparent renal disease (P < 0.01). Compared to initial values, mean urinary RBP decreased significantly in six patients evaluated after improvement of the exacerbation of renal disease. There was a positive correlation between urinary RBP and 24-h proteinuria (r = 0.40, P < 0.01), and an inverse correlation between urinary RBP and creatinine clearance (r = -0.60, P < 0.01). In a multivariate analysis adjusting for duration of disease, blood pressure, 24-h proteinuria, and creatinine clearance, mean urinary RBP continued to be significantly and progressively greater for patients with no renal disease, stable renal disease, probably active and active nephritis. Proximal tubular dysfunction is frequent in patients with active lupus nephritis. This association cannot be completely explained by the effects of increased total proteinuria, reduced glomerular filtration rate, and systemic hypertension. Urinary RBP seems to be a marker of renal disease activity. This test may be clinically useful to differentiate patients with active lupus nephritis from those with stable or absent renal disease.
我们通过检测尿视黄醇结合蛋白（RBP）评估了70例系统性红斑狼疮患者近端肾小管功能障碍的情况。采用不列颠群岛狼疮评估组（BILAG）指数评估肾脏疾病活动度。这是一个基于医生治疗意向原则的临床实验室评分。在22例活动性肾炎患者中有17例（77%）检测到尿RBP升高（>400微克/升），18例可能为活动性肾炎患者中有6例（33%），9例肾脏疾病稳定患者中有1例（12%），21例无明显肾脏疾病患者中有1例（5%）（P<0.01）。与初始值相比，6例在肾脏疾病加重改善后接受评估的患者尿RBP均值显著下降。尿RBP与24小时蛋白尿呈正相关（r=0.40，P<0.01），与肌酐清除率呈负相关（r=-0.60，P<0.01）。在对疾病持续时间、血压、24小时蛋白尿和肌酐清除率进行校正的多变量分析中，无肾脏疾病、肾脏疾病稳定、可能活动性和活动性肾炎患者的尿RBP均值仍持续显著且逐步升高。近端肾小管功能障碍在活动性狼疮性肾炎患者中很常见。这种关联不能完全由总蛋白尿增加、肾小球滤过率降低和系统性高血压的影响来解释。尿RBP似乎是肾脏疾病活动度的一个标志物。这项检测在临床上可能有助于区分活动性狼疮性肾炎患者与肾脏疾病稳定或无肾脏疾病的患者。
