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Alpha-1-Mikroglobulin in Urin und Serum bei Proteinurie und Niereninsuffizienz

Urinary and serum alpha-1-microglobulin in proteinuria and renal insufficiency

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Summary

Alpha-1-microglobulin (alpha-1-m) is a low molecular weight glycoprotein (mw 25–33 KD) that is filtered through the glomeruli and reabsorbed in the proximal parts of the renal tubules where it is catabolized. Normal ranges were established for alpha-1-m (100 healthy controls) in serum (20–42 mg/l) and urine (3.5–8 mg/l). Alpha-1-m was then measured in 341 urine samples whose protein pattern had been classified as “pathologic” and “normal” according to microelectrophoresis. Increased alpha-1-m concentrations were found in 266 out of 280 pathologic urines (5% false negative) and in 3 out of 61 normal urines (4% false positive). Beta-2-microglobulin (beta-2-m), total protein or protein test strips showed a poorer correlation to the electrophoretic results. Measurement of alpha-1-m is, therefore, the most sensitive of these methods for the detection of proteinuria. In 90 patients with low molecular weight proteinuria and either with or without renal insufficiency alpha-1-m concentrations were determined in both urine and serum. While all patients had elevated urinary alpha-1-m concentrations, increased serum values were only found in renal insufficiency (Ccrea<100 ml/min). Independently of these results, we were also able to establish that increased alpha-1-m levels are found at decreased glomerular filtration rates (Ccrea <70 ml/min). Pathologic alpha-1-m concentrations therefore only allow the conclusion of isolated tubular impairment when the GFR is greater than 70 ml/min. Data from 350 patients with various renal and hypertensive diseases showed that serum alpha-1-m is a more sensitive indicator of renal insufficiency, even in the so-called “creatinine blind” range (60–100 ml/min) of the GFR than either creatinine or beta-2-m.

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Abbreviations

Alpha-1-M:

alpha-1-Mikroglobulin

beta-2-M:

beta-2-Mikroglobulin

ELISA:

enzyme linked immunosorption assay

GFR:

glomeruläre Filtrationsrate

HMW:

high molecular weight

LMW:

low molecular weight

MG:

Molekulargewicht

MGE:

Mikrogelelektrophorese

NI:

Niereninsuffizienz

RID:

radiale Immundiffusion

VK:

Variationskoeffizient

Literatur

  1. Akerström B (1983) Tissue distribution of guinea pig alpha-1-microglobulin. Cell Mol Bio 29 (6):489–495

    Google Scholar 

  2. Bernard AM, Lauwerys RR (1981) Retinol binding protein in urine: a more partical index than urinary beta-2-microglobulin for the routine screening of renal tubular function. Clin Chem 27:1781–1782

    Google Scholar 

  3. Bricker NS, Schultze RD (1972) Renal function: General concepts. In: Maxwell MH, Cleeman CR: Clinical disorders of fluid and electrolyt metabolism: McGraw-Hill, New York

    Google Scholar 

  4. Cassuto JP, Krebs BP, Voit G, Dujardin P (1978) Beta-2-microglobulin, a tumour marker of lymphoproliferative disorders. Lancet II:108

    Google Scholar 

  5. Christensen EI, Renneke HG, Carone FA (1983) Renal tubular uptake of protein: effects of molecular charge. Am J Physiol 244:F436-F441

    Google Scholar 

  6. Davey PG, Gosling P (1982) Beta-2-microglobulin instability in pathological urine. Clin Chem 28:1330–1333

    Google Scholar 

  7. Ekström B, Berggard I (1977) Human alpha-1-microglobulin. Purification procedure, chemical and physicochemical properties. J biol Chem 252:8048–8057

    Google Scholar 

  8. Ekström B, Peterson PA, Berggard I (1975) A urinary and plasma alpha-1-glycoprotein of low molecular weight: isolation and some properties. Biochem biophys Res Commun 65:1472–1533

    Google Scholar 

  9. Evrin PE, Wibell L (1972) The serum levels and urinary excretion of beta-2-microglobulin in apparently healthy subjects. Scand J clin Lab Invest 29:69–74

    Google Scholar 

  10. Fleming IJ, Purapia L, Morgan DB, Chied JD (1980) Increased urinary beta-2-microglobulin after cancer chemotherapy. Cancer Treat Rep 64:581–588

    Google Scholar 

  11. Gekle D, Kult J, Hüttig H, Heidland H (1975) Beta-2-Mikroglobulin bei gesunden und nierenkranken Kindern. Z Kinderklinik 119:293–298

    Google Scholar 

  12. Gibey R, Dupond JL, Alber D, Leconte des Floris R, Henry JD (1982) Predictive value of urinary N-acetyl-beta-d-glucosaminidase, alanine-aminopeptidase and beta-2-microglobulin in evaluating nephrotoxicity of gentamicin. Clin Chim Acta 16:25–34

    Google Scholar 

  13. Hall PW, Ricanti ES, Vacca CV, Chung-Park M (1980) Renal metabolism of beta-2-microglobulin in kidney. Vox Sang 38:343–347

    Google Scholar 

  14. Hall PW, Ricanti ES (1981) Renal handling of beta-2-microglobulin in renal disorders: with special reference to hepatorenal syndrome. Nephron 27:62–66

    Google Scholar 

  15. Itoh Y, Kin K, Kasahara T, Sakurabayashi I, Kawai T, Shioiri-Nakano K, Takagi K (1979) Synthesis and secretion of alpha-1-microglobulin by human lymphocytes. Clin exp Immunol 37:134–139

    Google Scholar 

  16. Itoh Y (1981) Diurnal variation of serum alpha-1-microglobulin in normal subjects. Nephron 29:204

    Google Scholar 

  17. Itoh Y, Enomoto H, Takagi K, Kawai K (1983) Clinical usefulness of serum alpha-1-microglobulin as a sensitive indicator for renal insufficiency. Nephron 33:69–70

    Google Scholar 

  18. Jialal B, Nathoo C, Bejai S, Joubert SM (1982) Serum beta-2-microglobulin estimation as an indicator fo the glomerular filtration rate. S Afr med J 61:953–954

    Google Scholar 

  19. Karlsson FA, Wibell L (1980) Beta-2-microglobulin in clinical medicine. Scand J clin Lab Invest (Suppl) 154:27–37

    Google Scholar 

  20. Kawai T, Kin K (1975) Diurnal variation of serum beta-2-microglobulin in normal subjects. N Eng J Med 293:879–880

    Google Scholar 

  21. Kult J, Lämmlein C, Röckel A, Heidland A (1974) beta-2-Mikroglobulin im Serum — ein Parameter des Glomerulumfiltrates. Dtsch med Wochenschr 99:1686–1688

    Google Scholar 

  22. Merret J, Atkinson P, Burr M, Merrett TG (1980) Circulating levels of beta-2-microglobulin in the over 70s. Clin Chim Acta 104:199–123

    Google Scholar 

  23. Mogensen CE, Vittinghus E, Solling K (1975) Increased urinary excretion of albumin, light chains, and beta-2-microglobulin after intravenous arginine administration in normal man. Lancet II:581–582

    Google Scholar 

  24. Peterson PA, Berggard I (1971) Isolation and properties of a human retinol-transporting protein. J biol Chem 246:25–33

    Google Scholar 

  25. Reichel W, Wolfrum I, Klein R, Scheler F (1976) Differenzierung der Proteinurie durch die Mikroelektrophorese in kontinuierlichen Polyacrylamid-Gradientengelen. Klin Wochenschr 54:19–24

    Google Scholar 

  26. Sachs L (1984) Angewandte Statistik. 6. Aufl., Springer, Berlin Heidelberg New York Tokyo

    Google Scholar 

  27. Schardijn G, Statius van Eps LW, Schwaak AJG, Kager JCGM, Persijn JP (1979) Urinary beta-2-microglobulin in upper and lower urinary-tract infection. Lancet I:805

    Google Scholar 

  28. Schentag JJ, Sutfin TA, Plaut ME, Jusko WJ (1979) Early detection of aminoglycoside nephrotoxicity with urinary beta-2-microglobulin. J Med 9:201–210

    Google Scholar 

  29. Shea PH, Mahner JF, Horak E (1981) Prediction of glomerular filtration rate by serum creatinine andβ 2-microglobulin. Nephron 29:30–35

    Google Scholar 

  30. Strober W, Waldmann TA (1974) The role of the kidney in the metabolism of plasma proteins. Nephron 13:35–66

    Google Scholar 

  31. Svensson L, Ravnskov U (1976) Alpha-1-microglobulin, a new low molecular weight plasma protein. Clin Chim Acta 73:415–422

    Google Scholar 

  32. Takagi K, Kin K, Itoh Y, Kawai T, Kasahara T et al. (1979) Tissue distribution of human alpha-1-microglobulin. J Clin Invest 63:318–325

    Google Scholar 

  33. Takagi K, Kin K, Itoh Y, Enomoto H, Kawai T (1980) Human alpha-1-microglobulin levels in various body fluids. J Clin Pathol 33:786–791

    Google Scholar 

  34. Takagi K, Itho Y, Enomoto H, Koyamaishi Y, Maede K et al. (1980) A comparative study of serum alpha-1-microglobulin and beta-2-microglobulin levels in cancerous and other diseases. Clin chim Acta 108:277–283

    Google Scholar 

  35. Tejler LA, Grubb O (1976) A complex forming glycoprotein heterogeneous in charge and present in human plasma, urine, and cerebrospinal fluid. Biochim biophys Acta 439:82–94

    Google Scholar 

  36. Thomas L (1984) Labor und Diagnose. 2. Aufl., Medizinische Verlagsgesellschaft, Marburg

    Google Scholar 

  37. Trollfors B, Norrby R (1981) Estimation of glomerular filtration rate by serum creatinine and serum beta-2-microglobulin. Nephron 28:196–199

    Google Scholar 

  38. Viberti GC, Keen H, Mackintosh D (1981) Beta-2-microglobulin: a sensitive index of diminishing renal function in diabetics. Br Med J (Clin Res) 282:95–98

    Google Scholar 

  39. Weber MH, Bitter T, Scheler F (1983) Quantitative Protein-bestimmung im Urin. Lab Med 7: W + F 155–163

    Google Scholar 

  40. Wibell L, Karlsson LA (1976) Urinary excretion of beta-2-microglobulin after induction of diuresis. Nephron 17:343

    Google Scholar 

  41. Yu H, Yanagisawa Y, Forbes MA, Cooper EH, Crockson RA, I.C.M. MacLennan (1983) Alpha-1-microglobulin: an indicator protein for renal tubular function. J Clin Pathol 36:253–259

    Google Scholar 

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Weber, M.H., Scholz, P., Stibbe, W. et al. Alpha-1-Mikroglobulin in Urin und Serum bei Proteinurie und Niereninsuffizienz. Klin Wochenschr 63, 711–717 (1985). https://doi.org/10.1007/BF01733115

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  • DOI: https://doi.org/10.1007/BF01733115

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