Abstract
This study was designed to evaluate the occurrence and the type of proteinuria in 82 children with vesico-ureteric reflux (VUR) with or without renal scars. The urinary excretion of the high molecular weight protein albumin was taken as an index of glomerular alterations and the excretion of retinol-binding protein (RBP), β2-microglobulin and brush border antigens (BBA) (measured by monoclonal antibody-based enzyme-linked immunosorbent assay) was taken as an index of tubular alterations. All such markers were increased in children with VUR and were related to the degree of renal function. Patients showing reduced creatinine clearance had very high levels of albuminuria, microproteinuria and BBA, with all these varialbles reciprocally correlated. In children with normal renal function however, only microproteins (not albumin or BBA) were slightly increased, thus indicating an isolated tubular defect without involvement of the proximal segment of the tubule. However, microprotein excretion did not correlate with the grade of scarring (99mtechnetiumdimercaptosuccinic acid scan), both RBP and β2-microglobulin excretion being normal in 75% of children with radioisotopic signs of renal lesions but increased in 17% of children without scars. Therefore, tubular proteinuria identifies different groups of children with VUR but is not related to renal scarring. Prospective studies will define the usefulness of proteinuria as a reliable indicator of renal outcome.
Similar content being viewed by others
References
Miller T, Phillips S (1981) Pyelonephritis: the relation between infection, renal scarring and antimicrobial therapy. Kidney Int 19: 262–268
Slotki IN, Asscher AW (1982) Prevention of scarring in experimental pyelonephritis in the rat by early antibiotic therapy. Nephron 30: 262–268
Ransley PG, Risdon RA (1981) Reflux nephropathy: effects of antimicrobial therapy on the evolution of the early pyelonephritic scar. Kidney Int 20:733–742
Peterson PA, Evrin PE, Berggard I (1969) Differentiation of glomerular, tubular and normal proteinuria. Determination of urinary excretion of β2-microglobulin, albumin and total proteins. J Clin Invest 48: 1189–1198
Portman RJ, Kissane JM, Robson AM (1986) Use of β2-microglobulin to diagnose tubulo-interestitial renal lesions in children. Kidney Int 30:92–98
Bernard A, Lauwerys R (1981) Retinol-binding protein. A more practical index than β2-microglobulin for the routine screening of tubular function. Clin Chem 27:2121–2122
Mutti A, Lucertini S, Volcalvi PP, Neri TM, Fornarvi M, Alinovi R, Franchini I (1985) Urinary excretion of brush-border antigen: early indicator of toxic nephropathy. Lancet II:914–917
Mutti A, Lucertini S, Fornari M, Franchini I, Bernard A, Roels M, Lauwerys R (1985) Urinary excretion of brush-border antigen revealed by monoclonal antibodies in subjects occupationally exposed to heavy metals. Proceedings of an International Conference on Heavy Metals in the Environment, vol I. CEP, Edinburgh, pp 565–567
Goldraich IH, Goldraich NP, Ramos OL (1983) Classification of reflux nephropathy according to findings at DMSA renal scan. Eur J Pediatr 148:212–218
Valcalvi PP, Lucertini S, Mutti A, Chezzi C (1986) Urinary albumin. In: Bergmeyer HU (ed) Methods of enzymatic analysis, vol 9. VCH, Weinheim, pp 56–64
Lucertini S, Mutti A, Valcalvi PP, Franchini I (1984) Enzyme-linked immunosorbent assay of retinol-binding protein in serum and urine. Clin Chem 30:149–151
Siegel S (1956) Nonparametric statistics: for the behavioral science. McGraw-Hill, New York, pp 39–42
Snedecor GW, Corhran WG (1980) Statistical methods, 7th edn. Iowa State University Press, Ames, pp 215–233
Mayrer AR, Miniter P, Andriole VT (1983) Immunopathogenesis of chronic pyelonephritis. Am J Med 74:S59-S70
Bernard A, Amor AO, Viau C, Lauwerys R (1988) The renal uptake of proteins: a nonselective process in conscious rats. Kidney Int 34: 175–185
Bernard A, Viau C, Ouled A, Lauwerys R (1987) competition between low and high molecular weight proteins for renal tubular uptake. Nephron 45:115–118
Morsing P, Stenberg A, Muller-Suur C, Person EG (1987) Tubuloglomerular feedback in animals with unilateral, partial ureteral occlusion. Kidney Int 32:212–218
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ginevri, F., Mutti, A., Ghiggeri, G.M. et al. Urinary excretion of brush border antigens and other proteins in children with vesico-ureteric reflux. Pediatr Nephrol 6, 30–32 (1992). https://doi.org/10.1007/BF00856825
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00856825