Marder K, Keller F, Schuppan D
Free University Berlin, University Hospital Benjamin Franklin (Steglitz), Department of General Internal Medicine and Nephrology, Germany.
Clin Nephrol. 1995 Sep;44(3):178-84.
Chronic kidney diseases are characterized by alterations in connective tissue turnover resulting in fibrosis. We measured circulating peptides related to type VI collagen and undulin in serum and urine of 125 patients with various kidney diseases, on chronic hemodialysis and after kidney transplantation. Using a double-armed ELISA technique (median, 95% CI), normal serum concentrations for type VI collagen were 50 ng/ml [46-63] with no type VI collagen detectable in urine. Normal values for undulin were 215 ng/ml [207-241] in serum and 240 micrograms/d [223-284] in urine. The serum concentrations of undulin were most significantly (477 ng/mg [358-737]) increased in 18 hemodialysis patients. A significant increase (330 ng/ml [306-368]) was also observed in patients with various kidney diseases not requiring dialysis. No differences were found between the various forms of glomerulonephritis, interstitial nephritis and other kidney diagnoses. Although very low in normals (1.16 ml/min [1.05-1.27]) renal undulin clearance was even significantly lower in patients with kidney diseases (0.5 ml/min [0.4-0.6]). Serum concentrations for undulin were in the normal range in the direct postoperative phase after kidney transplantation (207 ng/ml [167-306]), whereas in kidney transplant out-patient levels were elevated to 425 ng/ml [357-563]. There was a slight but significant correlation between serum undulin and creatinine values and between renal undulin clearance and creatinine clearance. Values of serum type VI collagen increased in analogy to those of undulin. We conclude, that type VI collagen and undulin are novel serum parameters of renal extracellular matrix turnover that merit further exploration in patients with chronic kidney diseases.
慢性肾脏病的特征是结缔组织更新改变，进而导致纤维化。我们检测了125例患有各种肾脏疾病、接受慢性血液透析以及肾移植后的患者血清和尿液中与VI型胶原蛋白和内聚蛋白相关的循环肽。使用双臂ELISA技术（中位数，95%置信区间），VI型胶原蛋白的正常血清浓度为50 ng/ml [46 - 63]，尿液中未检测到VI型胶原蛋白。内聚蛋白的正常血清值为215 ng/ml [207 - 241]，尿液值为240微克/天 [223 - 284]。18例血液透析患者的血清内聚蛋白浓度升高最为显著（477 ng/mg [358 - 737]）。在不需要透析的各种肾脏疾病患者中也观察到显著升高（330 ng/ml [306 - 368]）。各种形式的肾小球肾炎、间质性肾炎和其他肾脏诊断之间未发现差异。尽管正常人的肾脏内聚蛋白清除率非常低（1.16 ml/分钟 [1.05 - 1.27]），但肾脏疾病患者的清除率甚至更低（0.5 ml/分钟 [0.4 - 0.6]）。肾移植术后直接阶段血清内聚蛋白浓度在正常范围内（207 ng/ml [167 - 306]），而肾移植门诊患者的水平升高至425 ng/ml [357 - 563]。血清内聚蛋白与肌酐值之间以及肾脏内聚蛋白清除率与肌酐清除率之间存在轻微但显著的相关性。血清VI型胶原蛋白值与内聚蛋白值类似地升高。我们得出结论，VI型胶原蛋白和内聚蛋白是肾脏细胞外基质更新的新型血清参数，值得在慢性肾脏病患者中进一步探索。
