Zhao Yijun,Chen Junyi,Tang Daxing.Clinical significance of urine protein measurement in children with severe hydronephrosis after percutaneous nephrostomy and correlation with renal function[J].Journal of Clinical Pediatric Surgery,,20():319-324.[doi:10.12260/lcxewkzz.2021.04.004]
Clinical significance of urine protein measurement in children with severe hydronephrosis after percutaneous nephrostomy and correlation with renal function
- CLC:
- R692.2;R696+.2
- Abstract:
- Objective To explore the clinical significance of pelvic urine microalbumin (mAlb), α1-microglobulin (α1-MG), β2-microglobulin (β2-MG), transferrin (Trf) and immunoglobulin G (IgG) with different molecular weight in children with severe hydronephrosis after percutaneous nephrostomy and analyze their correlation with renal function. Methods From March 2017 to October 2020, a total of 17 children hospitalized in the urology department of Children’s Hospital of Zhejiang University with unilateral severe hydronephrosis undergoing percutaneous nephrostomy were recruited.Renal function was assessed by renal radionuclide scanning and percutaneons nephrostomy surgery was performed.Pelvic urine was collected for urinary protein test.They were divided into two groups of lower DRF (n=11) and higher DRF (n=6) after 3 months according to DRF<22.1% and DRF ≥ 22.1%.The levels of affected renal pelvic urinary mAlb/Cr, α1-MG/Cr, β2-MG/Cr, Trf/Cr, IgG/Cr, (mAlb+Trf+IgG)/Cr and (α1-MG+β2-MG)/Cr were compared between two groups;changes of renal function, mAlb/Cr, α1-MG/Cr, β2-MG/Cr, Trf/Cr, IgG/Cr, (mAlb+Trf+IgG)/Cr and (α1-MG+β2-MG)/Cr were compared before and after percutaneous nephrostomy for 3 months.Correlation of urine proteins with renal function was analyzed. Results After percutaneous nephrostomy for 3 months, the levels of mAlb/Cr, α1-MG/Cr, (mAlb+Trf+IgG)/Cr and (α1-MG+β2-MG)/Cr were obviously higher in lower DRF group(DRF<22.1%) than in higher DRF group(DRF ≥ 22.1%) (P=0.035, P=0.005, P=0.035, P=0.002).There was obvious improvement of DRF after percutaneous nephrostomy for 3 months(P<0.01), the levels of urinary α1-MG/Cr, IgG/Cr and (α1-MG+β2-MG)/Cr of affected kidney declined markedly (P=0.025, P=0.035, P=0.022) and negative correlation existed between α1-MG/Cr and DRF (r=-0.436, P<0.05). Conclusion After percutaneous nephrostomy, the lower renal function the more damage of glomerulus and tubulars in children with severe hydronephrosis.Percutaneous nephrostomy is effective in improving DRF and membrane pore configuration of glomerular basement membrane in children with severe hydronephrosis.The improvement of renal function occurs mostly in recovery of renal tubules.Urinary α1-MG is a sensitive indicator of renal tubule improvement.And pelvic urine α1-MG may be employed as an valuable clinical indicator in evaluating affected renal function in children with severe hydronephrosis.
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Memo
收稿日期:2020-12-27。
基金项目:国家重点研发计划（编号：2018YFC1002700）
通讯作者:唐达星,Email:tangdx0206@zju.edu.cn