Childhood Kidney Diseases

  • 제13권1호
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  • Pages.56-62
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  • 2009
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  • 2384-0242(pISSN)
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  • 2384-0250(eISSN)
대한소아신장학회 (Korean Society of Pediatric Nephrology)
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방광요관 역류증 환아의 단회뇨에서 요단백 및 효소 배설 측정

Urinary Protein and Enzyme Excretion of Spot Urine in Children with Vesicoureteral Reflux

  • 윤정림 (인제대학교 의과대학 상계백병원 소아청소년과) ;
  • 구자욱 (인제대학교 의과대학 상계백병원 소아청소년과)
  • Yoon, Jung-Rim (Department of Pediatrics, College of Medicine, Inje University, Sanggye Paik Hospital) ;
  • Koo, Ja-Wook (Department of Pediatrics, College of Medicine, Inje University, Sanggye Paik Hospital)
  • 발행 : 2009.04.30
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초록

목 적 : 방광요관 역류증 환아의 단회뇨에서 요단백 및 효소(Microalbumin, NAG, ${\beta}_2$ MG)의 배설을 측정하여 방광요관 역류의 정도나 신손상을 조기에 예측 할 수 있는 지표로 의미가 있는지 알아보고자 하였다. 방 법 : 요로감염증으로 진단 받았던 91명의 환아 중 방광요관 역류와 신결손이 없었던 환아 I군 (n=62), 신결손은 없이 방광요관 역류만 있었던 환아는 II군(n=10), 신결손 및 방광요관 역류증을 모두 가지고 있었던 환아는 III군(n=19)으로 분류하여 아침첫 소변에서 microalbumin, NAG, ${\beta}_2$ MG를 측정하여 평균값을 비교하였다. 방광요관 역류 grade에 따라 VUR Grade I, II, III은 역류의 정도가 낮은 군으로 VUR grade IV, V는 역류가 높은 군으로 분류하여 요중 Microalbumin, NAG, ${\beta}_2$ MG값을 비교하였다. 결 과 : 단회뇨에서 측정한 microalbumin 값은 역류와 신결손이 있는 군이 없는 군과 비교하여 의미있게 증가되어 있었다(microalbumin: $42.3{\pm}27.2\;mg/gCr$ VS $25.2{\pm}10.9\;mg/gCr$, P<0.05). 단회뇨${\beta}_2$ MG, NAG의 평균값의 각 군간의 비교에서는 통계학적인 유의성이 없었다. 방광요관 역류가 높은 군에서 낮은 군보다 microalbumin 측정치가 의미 있게 증가되었다($23.4{\pm}7.7\;mg/gCr$ VS $39.3{\pm}22.1\;mg/gCr$, P<0.05). 결 론: 요로감염으로 진단받은 방광요관 역류증 환아에서 역류 정도와 역류성 신병증으로의 진행 여부를 예측하는 지표로 단회뇨의 microalbumin 측정이 유용하며, 외래에서 추적 관찰에 간편하게 이용할 수 있고 환아와 보호자의 순응도 상승에도 효과가 있을 것으로 기대된다.

Purpose : The aim of this study was to evaluate the clinical usefulness of measurement of ${\beta}_2$ microglobulin (${\beta}_2$ MG), N-acetyl-$\beta$-D-glucosaminidase (NAG) of spot urine samples as indices of renal tubular damage and microalbumin of spot urine samples as a parameter of glomerular damage in children with vesicoureteral reflux (VUR) or renal defects. Methods : We studied 91 children with previous UTI. The children were classified as 62 children without VUR and renal defects (group I), 10 children with VUR, without renal defects (group II), and 19 children with VUR and renal defects (group III). Patients having VUR were separated according to the degree of VUR (mild VUR: VUR grade I-III, severe VUR: VUR grade IV-V). Urinary excretion of ${\beta}_$ microglobulin (${\beta}_2$ MG), microalbumin, N-acetyl-$\beta$-D-glucosaminidase (NAG), creatinine were measured in samples of morning urine specimens. Children with VUR or renal defects detected by voiding cystourethrography (VCUG) and DMSA renal scan were investigated. Results : Microalbumin/Cr ratio of spot urine was significantly increased in group III compared group I ($42.3{\pm}27.2\;mg/gCr$ vs $25.2{\pm}10.9\;mg/gCr$, P<0.05). NAG/Cr ratio of spot urine was significantly increased in group II compared group I ($3.70{\pm}23.4\;mg/gCr$ vs $18.7{\pm}12.7\;mg/gCr$, P<0.05). There was no statistically significant difference of ${\beta}_2$ MG/Cr ratio among three groups. Conclusion : Urinary microalbumin excretion of morning urine sample may be a simple and reliable clinical indicators for early identification of renal damage in children with VUR and renal defects. Urinary microalbumin excretion may be useful marker to predict the the severity of VUR.

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참고문헌

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피인용 문헌

  1. Usefulness of Spot Urine β2-microglobulin in Pediatric Acute Pyelonephritis vol.18, pp.2, 2012, https://doi.org/10.15746/sms.12.018
  2. Predictive Risk Factors in Childhood Urinary Tract Infection, Vesicoureteral Reflux, and Renal Scarring Management vol.53, pp.12, 2009, https://doi.org/10.1177/0009922813515744