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Reliability of different expert systems for profiling proteinuria in children with kidney diseases

Pediatric Nephrology volume 23, pages 285–290 (2008)Cite this article

Abstract

This study was designed to compare three urinary protein expert systems for profiling proteinuria in children with kidney diseases. Freshly voided urine specimens were collected from 61 children with glomerular diseases, 19 children with tubular diseases and 25 healthy children aged 3–16 years. The urinary protein expert systems were: (1) albumin/total protein ratio (APR), (2) α-1-microglobulin/α-1-microglobulin + albumin algorithm (AAA), and (3) the complex urine protein expert system (UPES, PROTIS) algorithm. APR correctly identified glomerular proteinuria in 47/61 children, tubular proteinuria in 16/19 children and normal proteinuria in 23/25 healthy children. AAA correctly identified glomerular proteinuria in 61/61 children and tubular proteinuria in 18/19 children, and 25/25 healthy children were characterized as having no abnormal proteinuria. AAA was not influenced by the stage of chronic kidney disease. UPES differentiated the type of proteinuria in children with glomerular diseases into glomerular (50/61 patients) and mixed glomerulo-tubular (6/61 patients). Tubular proteinuria was identified in 16/19 patients and described as mixed glomerulo-tubular proteinuria in 3/19 patients. Mixed glomerulo-tubular proteinuria was found only in children with chronic kidney disease stages 2–5 of glomerular and tubular diseases. In conclusion, the AAA and UPES had the highest accuracy levels.

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References

  1. Guder WG, Ivandic M, Hofmann W (1998) Physiopathology of proteinuria and laboratory diagnostic strategy based on single protein analysis. Clin Chem Lab Med 36:935–939

    PubMed  Article  CAS  Google Scholar 

  2. Houser MT, Jahn MF, Kobayashi A, Walburn J (1986) Assessment of urinary protein excretion in the adolescent: effect of body position and exercise. J Pediatr 109:556–561

    PubMed  Article  CAS  Google Scholar 

  3. Hogg RJ, Portman RJ, Milliner D, Lemley KV, Eddy A, Ingelfinger J (2000) Evaluation and management of proteinuria and nephrotic syndrome in children: recommendations from a pediatric nephrology panel established at the National Kidney Foundation conference on proteinuria, albuminuria, risk, assessment, detection, and elimination (PARADE). Pediatrics 105:1242–1249

    PubMed  Article  CAS  Google Scholar 

  4. Bigazzi R, Bianchi S (1995) Microalbuminuria as a marker of cardiovascular and renal disease in essential hypertension. Nephrol Dial Transplant 10 Suppl 6:10–14

    PubMed  Google Scholar 

  5. Wanner C, Greiber S, Kirste G, Schollmeyer P, Horl WH (1988) Urinary proteinase activity in patients with acute renal failure after trauma and kidney transplantation. Adv Exp Med Biol 240:309–314

    PubMed  CAS  Google Scholar 

  6. Hofmann W, Guder WG (1989) Preanalytical and analytical factors in determination of urinary IgG, albumin, a1-microglobulin and retinol-binding protein with the Behring nephelometer system (BNS). Lab Med 13:470–478

    CAS  Google Scholar 

  7. Tencer J, Thysell H, Andersson K, Grubb A (1994) Stability of albumin, protein HC, immunoglobulin G, kappa- and lambda-chain immunoreactivity, orosomucoid and alpha 1-antitrypsin in urine stored at various conditions. Scand J Clin Lab Invest 54:199–206

    PubMed  Article  CAS  Google Scholar 

  8. Boege F (2005) Harnproteine. In: Thomas L (ed) Labor und Diagnose—Indikation und Bewertung von Laborbefunden für die medizinische Diagnostik. TH Books, Frankfurt/Main, pp 560–577

  9. Guder WG, Hofmann W (1998) Differentiation of proteinuria and hematuria by single protein analysis in urine. Clin Chem Lab Med 36:935–939

    PubMed  Article  CAS  Google Scholar 

  10. Abitbol CL, Chandar J, Onder AM, Nwobi O, Montane B, Zilleruelo G (2006) Profiling proteinuria in pediatric patients. Pediatr Nephrol 21:995–1002

    PubMed  Article  Google Scholar 

  11. Hofmann W, Edel H, Guder WG (1995) A mathematical equation to differentiate overload proteinuria from tubulo-interstitial involvement in glomerular diseases. Clin Nephrol 44:28–31

    PubMed  CAS  Google Scholar 

  12. Ivandic M, Hofmann W, Guder WG (2000) The use of knowledge-based systems to improve medical knowledge about urine analysis. Clin Chim Acta 297:251–260

    PubMed  Article  CAS  Google Scholar 

  13. Buchner A, Erdfelder E, Faul F (1996) Teststärkenanalysen (Power analyses). In: Erdfelder E, Mausfeld T, Meiser T, Rudinger G (eds) Handbuch quantitative Methoden. Psychologie Verlags Union, Weinheim, pp 123–136

    Google Scholar 

  14. Lun A, Ivandic M, Priem F, Filler G, Kirschstein M, Ehrich JH, Guder WG (1999) Evaluation of pediatric nephropathies by a computerized urine protein expert system (UPES). Pediatr Nephrol 13:900–906

    PubMed  Article  CAS  Google Scholar 

  15. Regeniter A, Siede WH, Seiffert UB (1996) Computer assisted interpretation of laboratory test data with ′MDI-LabLink′. Clin Chim Acta 248:107–118

    PubMed  Article  CAS  Google Scholar 

  16. Regeniter A, Siede WH, Scholer A, Huber P, Frischmuth N, Steiger JU (2001) Selectivity of proteinuria can be estimated reliably from samples of second-morning urine. Kidney Int 59:1595–1597

    PubMed  Article  CAS  Google Scholar 

  17. Regeniter A, Siede WH, Scholer A, Huber P, Frischmuth N, Steiger JU (2000) Interpreting complex urinary patterns with MDI LABLINK: a statistical evaluation. Clin Chim Acta 297:261–273

    PubMed  Article  CAS  Google Scholar 

  18. Schwartz GJ, Feld LG, Langford DJ (1984) A simple estimate of glomerular filtration rate in full-term infants during the first year of life. J Pediatr 104:849–854

    PubMed  Article  CAS  Google Scholar 

  19. Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, De Zeeuw D, Hostetter TH, Lameire N, Eknoyan G (2005) Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 67:2089–2100

    PubMed  Article  Google Scholar 

  20. Hogg RJ, Furth S, Lemley KV, Portman R, Schwartz GJ, Coresh J, Balk E, Lau J, Levin A, Kausz AT, Eknoyan G, Levey AS (2003) National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents: evaluation, classification, and stratification. Pediatrics 111:1416–1421

    PubMed  Article  Google Scholar 

  21. No authors listed (1980) Exakte Vertrauensgrenzen der Binomialverteilung. Wissenschaftliche Tabellen Geigy-Statistik. Basel, pp 89–102

  22. Redon J (2006) Measurement of microalbuminuria—what the nephrologist should know. Nephrol Dial Transplant 21:573–576

    PubMed  Article  Google Scholar 

  23. Lorentz K, Weiss T (1986) Protein determination in urine—a critical review. J Clin Chem Clin Biochem 24:309–323

    PubMed  CAS  Google Scholar 

  24. Comper WD, Osicka TM (2004) Albumin-like material in urine. Kidney Int 66:S65–S66

    Article  Google Scholar 

  25. Brück D, Hess R, Klakow-Franck R, Warlo H-J (2006) Laboratoriumsmedizin. Kommentar zur Gebührenordnung für Ärzte (GOÄ). Deutscher Ärzte-Verlag, Köln, pp 887–1266

    Google Scholar 

  26. No authors listed (2005) Laboratoriumsmedizin, Molekulargenetik und Molekularpathologie. In: Kassenärztliche Bundesvereinigung (ed) Einheitlicher Bewertungsmaßstab (EBM). Deutscher Ärzte-Verlag, Köln, pp 400–457

  27. Ojala R, Ala-Houhala M, Harmoinen AP, Luukkaala T, Uotila J, Tammela O (2006) Tubular proteinuria in pre-term and full-term infants. Pediatr Nephrol 21:68–73

    PubMed  Article  Google Scholar 

  28. Matos V, van Melle G, Boulat O, Markert M, Bachmann C, Guignard JP (1997) Urinary phosphate/creatinine, calcium/creatinine, and magnesium/creatinine ratios in a healthy pediatric population. J Pediatr 131:252–257

    PubMed  Article  CAS  Google Scholar 

  29. Matos V, van Melle G, Werner D, Bardy D, Guignard JP (1999) Urinary oxalate and urate to creatinine ratios in a healthy pediatric population. Am J Kidney Dis 34:e1

    PubMed  CAS  Google Scholar 

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Affiliations

  1. Central Institute of Laboratory Medicine and Pathobiochemistry, Humboldt University, Charité, Berlin, Germany

    Andreas Lun & Reinhard Ziebig

  2. Department of Paediatric Kidney, Liver and Metabolic Diseases, Children’s Hospital, Hanover Medical School, Carl Neuberg Str. 1, 30625, Hanover, Germany

    Marina Suslovych, Jens Drube & Jochen H. H. Ehrich

  3. Kinesiology Faculty, University of Zagreb, Zagreb, Croatia

    Leo Pavicic

Authors
  1. Andreas Lun
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  2. Marina Suslovych
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  3. Jens Drube
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  4. Reinhard Ziebig
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  5. Leo Pavicic
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  6. Jochen H. H. Ehrich
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Correspondence to Jochen H. H. Ehrich.

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Lun, A., Suslovych, M., Drube, J. et al. Reliability of different expert systems for profiling proteinuria in children with kidney diseases. Pediatr Nephrol 23, 285–290 (2008). https://doi.org/10.1007/s00467-007-0661-5

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  • DOI: https://doi.org/10.1007/s00467-007-0661-5

Keywords

  • Proteinuria
  • Expert system
  • Kidney diseases
  • Glomerular
  • Tubular
  • Diagnostics