Urinary Retinol-Binding Protein as a Prognostic Marker in the Treatment of Nephrotic Syndrome

Kirsztajn, Gianna Mastroianni; Nishida, Sônia K.; Silva, Marcelo de Souza; Ajzen, H; Pereira, Aparecido B.

doi:10.1159/000045727

Cited by 25 publications

(16 citation statements)

References 5 publications

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“…Urinary excretion of RBP is a sensitive and accurate indicator of early proximal tubular damage [17][18][19][20], with the advantage over other indicators of stability at all values of urinary pH [21]. Urinary microalbumin excretion indicates glomerular leak.…”

Section: Discussionmentioning

confidence: 99%

The effect of mannitol on renal function following cardio‐pulmonary bypass in patients with normal pre‐operative creatinine*

Yallop¹,

Sheppard

Smith

2008

Anaesthesia

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SummaryMannitol is often added to the cardiopulmonary bypass pump prime to reduce the incidence of renal dysfunction, but studies so far have been inconclusive. Urinary excretion of microalbumin and retinol binding protein are more sensitive than routine biochemical tests of renal function after cardiac surgery. We performed a double-blind, randomised, controlled trial in cardiac surgical patients with pre-operative plasma creatinine < 130 lmol.l )1 . Twenty patients received 0.5 g.kgof mannitol in the pump prime, whereas 20 control patients received an equivalent volume of Hartmann's solution. Blood and urine samples were taken on the day before surgery and daily for 5 days postoperatively for measurement of plasma urea and creatinine, urinary creatinine, retinol binding protein and microalbumin. We found no differences between the mannitol and control patients for any measured variable, and conclude that mannitol has little impact on renal function in patients with normal pre-operative plasma creatinine concentrations. Acute renal failure (ARF) affects around 5% of patients following cardiac surgery, with a mortality of 10-20% compared to 1% mortality in similar patients without ARF [1]. Even mild postoperative renal dysfunction is associated with increased morbidity and mortality [2,3]. ARF requiring dialysis occurs in 1-2% of patients, with a significantly higher mortality of 50-60%. ARF increases total hospital stay, duration of time spent in critical care, and triples the likelihood of discharge to extended care facilities [4][5][6][7], increasing the overall cost of hospital care. Mannitol was the earliest pharmacological prophylactic agent used to prevent ARF during cardiac surgery because it is an osmotic diuretic [8]. Mannitol is used in the pump prime in 37% of adult cardiac surgical units in the UK [9], but its use to preserve renal function in this setting remains controversial because the evidence of benefit is contradictory [8,[10][11][12][13][14][15]. This is due in part to the design of some previous studies, but also to the previous lack of sensitive tests for renal dysfunction [15].Retinol binding protein (RBP) is freely filtered at the glomerulus and is normally completely reabsorbed by proximal tubular cells [16], so only trace amounts are excreted. Urinary excretion of RBP is a sensitive and accurate indicator of early proximal tubular damage [17][18][19][20], with the advantage over other indicators of stability at all values of urinary pH [21]. Urinary microalbumin excretion indicates glomerular leak. The aim of this study was to assess the effect of mannitol on urinary concentrations of microalbumin and RBP as markers of renal dysfunction following CPB in patients with normal pre-operative plasma creatinine concentrations. MethodFollowing approval by the Local Research Ethics Committee, we studied 40 patients scheduled for first-time elective cardiac surgery. None of the patients had received radiographic contrast media in the preceding month. Patients whose weight was below 60 kg were

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Section: Discussionmentioning

confidence: 99%

The effect of mannitol on renal function following cardio‐pulmonary bypass in patients with normal pre‐operative creatinine*

Yallop¹,

Sheppard

Smith

2008

Anaesthesia

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“…We decided to classify them this way because in a previous study we observed that urRBP behaved differently in relation to that feature [18]. It should be mentioned that all IgA nephropathy cases were classified arbitrarily as proliferative, although sometimes they were not.…”

Section: Discussionmentioning

confidence: 99%

“…As this parameter has been extensively studied at our institute [18,19,20], where an adequate method for determination of RBP has been developed [21,22,23], it will be analyzed here.…”

Section: Introductionmentioning

confidence: 99%

Relative Contribution of Morphometric and Functional Indicators of Tubulointerstitial Lesion to Glomerular Diseases Prognosis

Deus¹,

Teixeira²,

Kirsztajn³

2008

Nephron Clin Pract

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Background: Early diagnosis of proximal tubular lesions can be achieved by detecting abnormal levels of low molecular weight proteins in urine. Material and Methods: 100 cases of glomerulopathies were retrospectively studied to establish the profile of urinary levels of retinol-binding protein (urRBP) and their correlation with histological markers of tubulointerstitial lesions in renal biopsies. The histological study included staining with picrosirius red. Results: Nonproliferative glomerulopathies, male sex, white race and young adults were predominant. The chance of abnormal urRBP occurring was higher among patients with a predominant proliferative component, baseline serum creatinine >1.2 mg/dl (p = 0.008), creatinine clearance <70 ml/min (p = 0.006), and severe interstitial fibrosis (p = 0.042). In multivariate analysis, only serum creatinine and creatinine clearance were independently associated to urRBP, and only urRBP was a time-independent prognostic factor for survival without renal failure (risk of renal failure: 9×). Conclusion: Our study suggests that urRBP determination is prognostically relevant in the progression of glomerulopathies; on the other hand, the evaluated morphometric markers correlated poorly with the clinical outcome of these patients. Consequently, urRBP determination, as a functional marker of tubulointerstitial damage, was more appropriate for determining the prognosis of glomerular diseases than the morphometric analysis of renal biopsies.

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“…We observed that an initial urRBP determination is less sensitive than those ones performed after some time of follow-up and particularly if an immunosuppressive treatment is used, because during treatment some patients have their urRBP levels normalized [17]. So, a determination of urRBP at 6 months of follow-up better reflects the outcome of these patients, possibly because they are more stable and an eventual effect of treatment is already present.…”

Section: Discussionmentioning

confidence: 99%

“…Those patients who progressed to chronic renal failure had high urRBP since the beginning of follow-up, independently of being or not treated with corticosteroid or other immunosuppressive regimens. The influence of the treatment of these patients on urRBP levels and outcome of the disease is addressed in detail elsewhere [17]. …”

Section: Discussionmentioning

confidence: 99%

Urinary Retinol-Binding Protein as a Prognostic Marker in Glomerulopathies

Kirsztajn¹,

Nishida²,

Silva³

et al. 2002

Nephron

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Tubulointerstitial involvement seems to have a decisive influence on the progression of glomerular diseases. We have prospectively evaluated the levels of urinary retinol-binding protein (urRBP), a marker of proximal tubular dysfunction, in patients with different glomerulopathies (GPs) and correlated these levels with disease progression. By studying 238 patients with GPs, we found that urRBP tend to be lower in minimal change disease, glomerular hematuria and poststreptococcal glomerulonephritis as compared to focal segmental glomerulosclerosis, membranous nephropathy and membranoproliferative glomerulonephritis. By following 149 patients for up to 10 years, we have concluded that high levels of urRBP can identify patients who will progress with loss of renal function (defined as doubling of serum creatinine level) and that a urRBP level >1 mg/l was an efficient and independent indicator of poor prognosis as shown by multivariate analysis. This prediction was possible at a time when serum creatinine and creatinine clearance were still in the normal range. Our data suggest that this laboratory test adds important clinical information to the follow-up of GPs.

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Urinary Retinol-Binding Protein as a Prognostic Marker in the Treatment of Nephrotic Syndrome

Cited by 25 publications

References 5 publications

The effect of mannitol on renal function following cardio‐pulmonary bypass in patients with normal pre‐operative creatinine*

The effect of mannitol on renal function following cardio‐pulmonary bypass in patients with normal pre‐operative creatinine*

Relative Contribution of Morphometric and Functional Indicators of Tubulointerstitial Lesion to Glomerular Diseases Prognosis

Urinary Retinol-Binding Protein as a Prognostic Marker in Glomerulopathies

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