Alpha-1-microglobulin: an indicator protein for renal tubular function.

Yu, Hai; Yanagisawa, Yukio; Forbes, M A; Eh, Cooper; Crockson, R. A.; MacLennan, Ian C. M.

doi:10.1136/jcp.36.3.253

Cited by 183 publications

(87 citation statements)

References 23 publications

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“…17 It can be used for diagnosing tubular damage and it is a sensitive marker for the early phase of renal failure. 18 N-acetyl-ß-glucosaminidase (ß-NAG) is widely used for the assessment of renal disease and the detection of nephrotoxicity. 19 It is a lysosomal enzyme found mainly in proximal tubular cells.…”

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confidence: 99%

RETRACTED ARTICLE: Diltiazem may preserve renal tubular integrity after cardiac surgery

Piper

Kumle

Maleck

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To evaluate the influence of dopamine and diltiazem on renal function and markers for acute renal failure, including urinary alpha-glutathion s-transferase (α-GST), alpha-1-microglobulin (α 1 -MG) and N-acetyl-ß-glucosaminidase (ß-NAG) after extracorporeal circulation.M Me et th ho od ds s: : In a randomized, placebo-controlled, double-blind trial we evaluated the efficacy of dopamine (2.5 µg·kg -1 ·min -1 ), diltiazem (2 µg·kg -1 ·min -1 ) or placebo administered over 48 hr postoperatively to maintain renal tubular integrity in 60 elective cardiac surgery patients. α-GST, α 1 -MG, ß-NAG, and creatinine clearance were measured from urine collected during surgery (T0), the first four hours (T1), 24 hr (T2) and 48 hr (T3) postoperatively.R Re es su ul lt ts s: : Cumulative urine output in the diltiazem group (9.0 ± 2.8 L) increased significantly compared with placebo (7.0 ± 1.6 L), but not compared with dopamine (7.8 ± 1.8 L). Creatinine clearance showed no significant intergroup differences. In all groups α 1 -MG increased from T0 to T3, but we found no significant intergroup differences. α-GST increased significantly from T0 to T3 in the placebo (2.1 ± 1.8 to 11.4 ± 8.6 µg·L -1 ) and in the dopamine groups (2.7 ± 1.8 to 13.6 ± 14.9 µg·L -1 ), but not in the diltiazem group (1.8 ± 1.4 to 3.2 ± 3.2 µg·L -1 ). Forty-eight hours postoperatively α-GST was significantly lower in the diltiazem group than in both other groups.C Co on nc cl lu us si io on ns s: : Diltiazem stimulates urine output, reduces excretion of α-GST and ß-NAG and may be useful to maintain tubular integrity after cardiac surgery. Objectif : Évaluer l'influence de la dopamine et du diltiazem sur la fonction rénale et les paramètres de l`insuffisance rénale aiguë, y compris l'alpha-glutathion S-transférase (α -GST), l'alpha-microglobuline (α 1 -MG) et la N-acétyl-ß glucosaminidase (ß-NAG) urinaires après circulation extracorporelle. Méthode : Soixante patients opérés pour un pontage aortocoronarien ont participé à un essai randomisé en double aveugle et contrôlé contre placebo pour mesurer l'efficacité de la dopamine (2,5 µg kg -1 min -1 ), du diltiazem (2 µg kg -1 min -1 ) ou d'un placebo administrés pendant 48 h postopératoires pour maintenir l'intégrité tubulaire rénale. L' α-GST, l' α 1 -MG et la ß-NAG et la clairance de la créatinine ont été mesurés dans l'urine recueillie pendant l'intervention chirurgicale (T0), quatre heures (T1), 24 h (T2) et 48 h (T3) après l'opération.Résultats : L'excrétion urinaire cumulative a augmenté significativement dans le groupe diltiazem (9,0 ± 2,8 L) comparé au groupe placebo (7,0 ± 1,6 L) mais ne différait pas dans le groupe dopamine (7,8 ± 1,8 L). Il n'y avait pas de différence significative intergroupe concernant la clairance de la créatinine. Tous les groupes montraient une augmentation d' α 1 -MG de T0 à T3, sans aucune différence significative entre les groupes. L' α-GST a augmenté de manière significative de T0 à T3 dans les groupes placebo (2,1 ± 1,8 à 11,4 ± 8,6 µg L -1 ) et d...

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confidence: 99%

RETRACTED ARTICLE: Diltiazem may preserve renal tubular integrity after cardiac surgery

Piper

Kumle

Maleck

et al. 2003

Can J Anesth/J Can Anesth

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“…It has also been used to monitor renal function in postoperative patients (10) and in patients on immunosuppressive therapy (11). It has the advantage over ␤ 2 -microglobulin, another tubular marker, in that it is stable at a low pH (4).…”

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confidence: 99%

Urinary α1-Microglobulin as a Marker of Nephropathy in Type 2 Diabetic Asian Subjects in Singapore

et al. 2003

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SING-LIN LING, MBBS, MSC 2OBJECTIVE -This study examines urinary ␣ 1 -microglobulin as a marker of early nephropathy in type 2 diabetic Chinese, Malays, and Asian Indians in Singapore. RESEARCH DESIGN AND METHODS-A cross-sectional study was performed on 590 consecutive type 2 diabetic patients (296 males, 294 females) who were on routine follow-up at a primary care clinic. Information was obtained from interviews, case notes, and blood and urine samples. Because the distribution of urinary ␣ 1 -microglobulin levels was highly skewed, these levels were log-transformed, and geometric means were calculated. There was correction for variability in urine flow by dividing by urine creatinine levels, given as mg/mmol urine creatinine, and adjustment for confounding variables.RESULTS -Urinary ␣ 1 -microglobulin was higher in men than in women and was directly related to age, but no ethnic differences were apparent. It was directly related to duration of diabetes, with adjusted geometric means of 1.19 and 1.43 mg/mmol urine creatinine for a duration of Ͻ10 and Ն10 years, respectively (P ϭ 0.07). Urinary ␣ 1 -microglobulin was highest in patients on insulin, followed by those on oral medication and then those on diet alone (adjusted geometric means: 1.47, 1.36, and 0.86 mg/mmol urine creatinine, respectively; P ϭ 0.01). Levels were also higher in patients with poor glucose control, as measured by HbA 1c , fasting plasma glucose, and 2-h postprandial plasma glucose (P Ͻ 0.01 for each). Urinary ␣ 1 -microglobulin was directly related to albuminuria, with adjusted geometric means for normoalbuminuria, microalbuminuria, and macroalbuminuria of 1.06, 1.47, and 4.72 mg/mmol urine creatinine, respectively (P Ͻ 0.01). However, of patients with normoalbuminuria, 33.6% had raised urinary ␣ 1 -microglobulin. Likewise, of patients with normal urinary ␣ 1 -microglobulin, 27.6% had albuminuria.CONCLUSIONS -Urinary ␣ 1 -microglobulin was related to duration, severity, and control of diabetes. Urinary ␣ 1 -microglobulin and albumin were directly related, but in some patients, one was present in the absence of the other. Hence, in addition to albuminuria (which measures glomerular dysfunction), urinary ␣ 1 -microglobulin (which measures proximal tubular dysfunction) is useful for the early detection of nephropathy in diabetic subjects.

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“…We monitored the excretion in urine of 4 specific proteins: ␣ 1 -microglobulin, also called protein HC (26.7 kDa), an established marker of renal tubular function (11,12 ); albumin (69 kDa) and IgG (150 kDa), established markers of glomerular permeability (7 ); and orosomucoid (42 kDa). Orosomucoid is an acute-phase reactant assumed to have immunomodulatory and antiinflammatory effects (13 ) as well as a role in maintaining barriers for transendothelial transport of macromolecules (14 ).…”

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Monitoring Urinary Orosomucoid in Acute Inflammation: Observations on Urinary Excretion of Orosomucoid, Albumin, α1-Microglobulin, and IgG

et al. 2005

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Background: Inflammation-associated proteinuria in acute, nonrenal disease is a common but poorly understood phenomenon. We performed an observational study of the urinary excretion of orosomucoid (␣ 1 -acid glycoprotein), albumin, ␣ 1 -microglobulin (protein HC), and IgG to obtain quantitative and temporal data on these 4 proteins. Methods: Urine samples were collected at daily intervals for up to 23 days from 6 patients with surgeryinduced inflammation and at hourly intervals for a 24-h period from 7 sepsis patients. Urinary protein concentrations were assessed by immunoturbidimetry. Results: During surgery-induced inflammation, the increase and decrease in orosomucoid excretion mirrored changes in plasma C-reactive protein. Values for all 4 urinary proteins were increased in sepsis patients. The observed maximum increases in urinary protein excretion relative to the upper reference values were 280-fold for orosomucoid, 98-fold for ␣ 1 -microglobulin, 33-fold for albumin, and 26-fold for IgG. Conclusions: Orosomucoid, usually present in plasma and urine in much lower concentrations than albumin, is increased in urine to concentrations equal to or higher than albumin in proteinuria associated with acute inflammation. The pathophysiologic mechanisms responsible for this markedly increased excretion are unknown. Monitoring of urinary excretion of orosomucoid and other specific proteins, expressed as protein/creatinine ratios, may provide a window for clinically rele-

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Alpha-1-microglobulin: an indicator protein for renal tubular function.

Cited by 183 publications

References 23 publications

RETRACTED ARTICLE: Diltiazem may preserve renal tubular integrity after cardiac surgery

RETRACTED ARTICLE: Diltiazem may preserve renal tubular integrity after cardiac surgery

Urinary α1-Microglobulin as a Marker of Nephropathy in Type 2 Diabetic Asian Subjects in Singapore

Monitoring Urinary Orosomucoid in Acute Inflammation: Observations on Urinary Excretion of Orosomucoid, Albumin, α1-Microglobulin, and IgG

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