Konda R, Sakai K, Ota S, Takeda A, Chida N, Sato H, Orikasa S
Department of Urology, Tohoku University School of Medicine, Sendai, Japan.
J Urol. 1998 Feb;159(2):535-9. doi: 10.1016/s0022-5347(01)63979-x.
Serum soluble interleukin-2 receptor level is a sensitive and quantitative marker of lymphocyte activation. We determined levels of serum soluble interleukin-2 receptor in children with reflux nephropathy to evaluate its clinical significance in the prediction for the progression of renal injuries.
Serum soluble interleukin-2 receptor values were determined in 63 children with reflux nephropathy. The group consisted of 37 boys and 26 girls 10 to 18 years old. T cells (naive and memory), B cells and macrophages were evaluated immunohistochemically in the scarred kidneys of 4 other patients (3 boys and 1 girl 5 to 16 years old) who underwent nephrectomy due to severe reflux nephropathy with little function seen on (99m)technetium-dimercapto-succinic acid (DMSA) renal scan. Levels of serum soluble interleukin-2 receptor were measured by an enzyme-linked immunosorbent assay. We simultaneously determined serum levels of creatinine and beta2-microglobulin, and urinary levels of alpha1-microglobulin and microalbumin. Individual functions of the right and left kidneys were estimated by renal dimercaptosuccinic acid uptake.
Levels of serum soluble interleukin-2 receptor in the patients who had low total uptake of DMSA (right uptake plus left uptake) were significantly higher than those from patients with normal total uptake. Levels of serum soluble interleukin-2 receptor correlated significantly with levels of creatinine (r=0.616, p <0.0001) and beta2-microglobulin (r=0.803, p <0.0001), and levels of urinary alpha1-microglobulin (r=0.753, p <0.0001) and microalbumin (r=0.673, p <0.0001). A significant negative correlation was observed between levels of serum soluble interleukin-2 receptor and total DMSA uptake values (right uptake plus left uptake r=-0.678, p <0.0001). In the scarred kidneys leukocyte infiltrates were markedly increased in fibrosed spaces. The predominant cell type in these lesions was memory T cells.
These results suggest that elevated levels of serum soluble interleukin-2 receptor are likely to reflect activated T cells in the kidneys of patients with reflux nephropathy and may be a useful predictor of progression of renal injury in these children.
血清可溶性白细胞介素-2受体水平是淋巴细胞活化的敏感定量标志物。我们测定了反流性肾病患儿血清可溶性白细胞介素-2受体水平，以评估其在预测肾损伤进展中的临床意义。
测定了63例反流性肾病患儿的血清可溶性白细胞介素-2受体值。该组由37名男孩和26名女孩组成，年龄在10至18岁之间。对另外4例因严重反流性肾病行肾切除术的患者（3名男孩和1名女孩，年龄5至16岁）的瘢痕肾进行免疫组织化学评估，这些患者在锝-二巯基丁二酸（DMSA）肾扫描中显示肾功能不佳。采用酶联免疫吸附测定法测量血清可溶性白细胞介素-2受体水平。我们同时测定了血清肌酐和β2-微球蛋白水平，以及尿α1-微球蛋白和微量白蛋白水平。通过肾二巯基丁二酸摄取评估左右肾的个体功能。
DMSA总摄取量（右肾摄取量加左肾摄取量）低的患者血清可溶性白细胞介素-2受体水平显著高于总摄取量正常的患者。血清可溶性白细胞介素-2受体水平与肌酐水平（r = 0.616，p <0.0001）、β2-微球蛋白水平（r = 0.803，p <0.0001）、尿α1-微球蛋白水平（r = 0.753，p <0.0001）和微量白蛋白水平（r = 0.673，p <0.0001）显著相关。血清可溶性白细胞介素-2受体水平与DMSA总摄取值（右肾摄取量加左肾摄取量r = -0.678，p <0.0001）之间存在显著负相关。在瘢痕肾中，纤维化间隙中的白细胞浸润明显增加。这些病变中的主要细胞类型是记忆T细胞。
这些结果表明，血清可溶性白细胞介素-2受体水平升高可能反映反流性肾病患者肾脏中活化的T细胞，可能是这些儿童肾损伤进展的有用预测指标。
