Konda R, Sakai K, Ota S, Takeda A, Orikasa S
Department of Urology, Tohoku University School of Medicine, Sendai, Japan.
J Urol. 1997 Mar;157(3):975-9.
We evaluated data collected for 10 years on children with reflux nephropathy to identify a means of predicting the prognosis.
A total of 15 boys and 13 girls were enrolled in this study at least 2 years after surgical and spontaneous resolution of vesicoureteral reflux in 25 and 3 patients, respectively. They were followed for more than 10 years and renal function was periodically evaluated. Urinary beta 2-microglobulin, alpha 1-microglobulin, N-acetyl-beta-D-glucosaminidase, microalbumin and 99mtechnetium dimercapto-succinic acid uptake were measured.
Of the 28 patients 12 had high levels of urinary alpha 1-microglobulin during followup, including all 7 in whom renal function deteriorated. In 3 children with elevated alpha 1-microglobulin urinary microalbumin gradually increased after puberty. Although elevated levels of urinary beta 2-microglobulin, N-acetyl-beta-D-glucosaminidase and microalbumin were also observed, they were less predictive of renal function than alpha 1-microglobulin.
These results suggest that elevated urinary levels of alpha 1-microglobulin may predict the risk of abnormal renal function in children with reflux nephropathy even before the appearance of significant proteinuria.
我们评估了10年间收集的反流性肾病患儿的数据，以确定一种预测预后的方法。
本研究共纳入15名男孩和13名女孩，他们分别在25例和3例膀胱输尿管反流手术和自然缓解至少2年后入组。对他们进行了超过10年的随访，并定期评估肾功能。检测尿β2-微球蛋白、α1-微球蛋白、N-乙酰-β-D-氨基葡萄糖苷酶、微量白蛋白和99m锝二巯基丁二酸摄取情况。
28例患者中，12例在随访期间尿α1-微球蛋白水平较高，其中肾功能恶化的7例全部在此列。3例α1-微球蛋白升高的儿童，青春期后尿微量白蛋白逐渐增加。虽然也观察到尿β2-微球蛋白、N-乙酰-β-D-氨基葡萄糖苷酶和微量白蛋白水平升高，但它们对肾功能的预测性不如α1-微球蛋白。
这些结果表明，即使在出现明显蛋白尿之前，尿α1-微球蛋白水平升高也可能预测反流性肾病患儿肾功能异常的风险。
