Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
권호 표지
DOI QR코드

DOI QR Code

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

방광요관 역류증 환아의 단회뇨에서 요단백 및 효소 배설 측정

  • 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)
  • 윤정림 (인제대학교 의과대학 상계백병원 소아청소년과) ;
  • 구자욱 (인제대학교 의과대학 상계백병원 소아청소년과)
  • Published : 2009.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

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.

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.

Keywords

References

  1. Sargent MA. What is the normal prevalence of vesicoureteral reflux? Pediatr Radiol 2000;30:587-93. https://doi.org/10.1007/s002470000263
  2. Brakeman P. Vesicoureteral reflux, reflux nephropathy, and end-stage renal disease. Adv Urol 2008;2008:1-7.
  3. Bailey RR. Vesico-ureteric reflux and reflux nephropathy. Kidney Int 1993;42:80-5.
  4. Hu P, Deng FM, Liang FX, Hu CM, Auerbach, Shapiro E et al. Ablation of uroplakin III gene results in small urothelial plaques, urothelial leakage, and vesicoureteral reflux. J Cell Biol 2000;151:961-72. https://doi.org/10.1083/jcb.151.5.961
  5. Barroso JR, Barroso D, Jacobino M, Vinhaes A, Macedo A, Srougi M. Etiology of urinary tract infection in scholar children. Int Braz J Urol 2003;29:450-4. https://doi.org/10.1590/S1677-55382003000500012
  6. Basic J, Golubovic E, Miljkovic P, Bjelakovic G, Cvetkovic T, Mlosevic V. Microalbuminuria in Children with Vesicoureteral Reflux. Ren Fail 2008;30:639-43. https://doi.org/10.1080/08860220802134805
  7. Obling H. Vesico-uretero-reanl reflux and kidney. Pediatr Nephrol 1987;1:638-46. https://doi.org/10.1007/BF00853602
  8. Westhuyzen J, Zoltan HE, Reece G, Reith DM, Saltissi D, Morgan TJ. Measurement of tubular enzymuria facilitates early detection of acute renal impairment in the intensive care unit. Nephrol Dial Transplant 2003;18:543-51. https://doi.org/10.1093/ndt/18.3.543
  9. Price RG. The role of NAG (N-acetyl-${\beta}$-Dglucosaminidase) in the diagnosis of kidney disease including the monitoring of nephrotoxicity. Clin Nephrol 1992;38(Suppl 1):14-9.
  10. Tomlinson PA, Smellie JM, Prescod N, Dalton RN, Chantler C. Differential excretion of urinary proteins in children with vesicoureteric reflux and reflux nephropathy. Pediatr Nephrol 1994;8:21-5. https://doi.org/10.1007/BF00868252
  11. Skalova S. The diagnostic role of urinary Nacetyl-${\beta}$-D-glucosaminidase (NAG) activity in the detection of renal tubular impairment.Acta Medica 2005;48:75-80.
  12. Sakai K, Konda R, Orikasa S, Ota S, Kaneda T, Ikeda S, et al. Studies on reflux nephropathy-renal tubular and glomerular damage evaluated by various urinary indices. Nippon Hinyokika Gakkai Zasshi 1993;84:364-73.
  13. Gutteberg TJ, Stromme P, Saebo-Larsen J, Flaegstad T. Unilateral vesicoureteral reflux in children. study on urine specific gravity, osmolality, beta-2-microglobulin and lactoferrin. Eur Urol 1987;13:390-2. https://doi.org/10.1159/000472830
  14. Carr MC, Peters CA, Retik AB, Mandell J. Urinary levels of renal tubular enzyme Nacetyl-${\beta}$-D-glucosaminidase in relation to grade of vesicoureteral reflux. J Urol 1991;146:654-6. https://doi.org/10.1016/S0022-5347(17)37885-0
  15. Kim JH, Kim PK. Significance of random urine ${\beta}_{2}$ microglobulin as a maker for vesico-ureteral reflux in children with urinary tract infection. J Korean Soc Pediatr Nephrol 1999;3:72-9.
  16. Jeon SH, Lee KC, Yoo KH. Non-radiologic methods for predicting vesicoureteral reflux in childhood urinary tract infection. J Korean Soc Pediatr Nephrol 1997;1:38-45.
  17. Jung DA, Koo JW. Urinary exceretion of various urinary proteins in children with vesicouretral reflux. Korean J Pediatr 2003;46:977-82.
  18. Lebowitz RL, Olbling H, Parkkulainen KV, Smellie JM, Tammine-Mobius TE. International system of radiographic grading of vesicoureteric reflux. Pediatr Radiol 1985;15:105-9. https://doi.org/10.1007/BF02388714
  19. Lebowitz RL. The detection and characterization of vesicoureteral reflux in the child. J Urol 1992;148:1640-2. https://doi.org/10.1016/S0022-5347(17)36991-4
  20. Caione P, Villa M, Capozza N, De Gennaro M, Rizzoni G. Predictive risk factors for chronic renal failure in primary high-grade vesicoureteric reflux. BJU Int 2004;93:1309-12. https://doi.org/10.1111/j.1464-410X.04866.x
  21. Williams MR, Jones D, Noe HN. Urinary Nacetyl-beta-glucosaminidase as a screening technique for vesocoureteral reflux. Urology 1994;43:528-30. https://doi.org/10.1016/0090-4295(94)90248-8
  22. Zajaczkowska M, Bienias B, Borzecka H, Sikora P, Majewski M, Bojarska-Junak A. Serum TGF-beta1 level in children with reflux nephropathy. Przegl Lek 2006;63(Suppl 3):121-3.
  23. Miyakita H, Puri P. Urinary levels of Nacetyl-beta-glucosaminidase: a simple marker for predicting tubular damage in higher grades of vesicoureteric reflux. Eur Urol 1994;25:135-7. https://doi.org/10.1159/000475267
  24. Brunskill NJ. Molecular interactions between albumin and proximal tubular cells. Exp Nephrol 1998;6:491-5. https://doi.org/10.1159/000020562
  25. Nam HY, Shin JH, Lee JH, Choi EN, Park HW. Vesicoureteral reflux and renal scar. J Korean Soc Pediatr Nephrol 2006;10:201-12.
  26. Smellie JM, Poulton A, Prescod NP. Retrospective study of children with renal scarring associated with reflux and urinary infection. BMJ 1994;308:1193-6. https://doi.org/10.1136/bmj.308.6938.1193
  27. Goldman M, Bistritzer T, Horne T, Zoareft I, Aladjem M. The etiology of renal scars in infant with pyelonephritis and vesicoureteral reflux. Pediatr Nephrol 2000;14:385-8. https://doi.org/10.1007/s004670050779
  28. Scherz HC, Downs TM, Caesar R. The selective use of dimercaptosuccinic acid renal scans in children with vesicoureteral reflux. J Urol 1994;152:628-31. https://doi.org/10.1016/S0022-5347(17)32668-X

Cited by

  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