A modern approach to selectivity of proteinuria and tubulointerstitial damage in nephrotic syndrome

Bazzi, Claudio; Petrini, Concetta; Rizza, Virginia; Arrigo, Girolamo; D’Amico, Giuseppe

doi:10.1046/j.1523-1755.2000.00334.x

Cited by 118 publications

(68 citation statements)

References 27 publications

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“…Moreover, cIgAN is characterized by a significantly higher rate of global glomerulosclerosis, larger extent of tubulointerstitial damage, and higher fractional excretion of ␣1m, a low molecular weight protein significantly correlated with the extent of TID in this study (r ϭ 0.664, P Ͻ 0.0001) and in other glomerulonephritides (12,14). The high degree of correlation between TID score, FEIgG (r ϭ 0.725), and u␣2m/g uCr (r ϭ 0.497) may suggest a pathogenetic link between excretion of high molecular weight proteins and the extent of TID as we showed in other glomerulonephritides in which selectivity index (15) or IgG excretion (12,14) was correlated with extent of TID.…”

Section: Discussionsupporting

confidence: 79%

In Crescentic IgA Nephropathy, Fractional Excretion of IgG in Combination with Nephron Loss Is the Best Predictor of Progression and Responsiveness to Immunosuppression

Bazzi¹,

Rizza²,

Raimondi³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: The aim of this study was to evaluate the relationship between proteinuric markers (urinary excretion of IgG, ␣2-macroglobulin, ␣1-microglobulin) and serum creatinine (sCr), histologic lesions, progression, and immunosuppression responsiveness in crescentic IgA nephropathy.Design, setting, participants, & measurements: Fractional excretion of IgG (FEIgG) and of ␣1-microglobulin and urinary excretion of ␣2-macroglobulin were evaluated in 37 patients, 23 treated with steroids and cyclophosphamide. For assessment of the effective tubular load of proteins in surviving nephrons, new markers that take into account not only the absolute excretion value but also nephron loss were obtained dividing proteinuric markers for percentage of nonobsolescent glomeruli (surviving glomeruli [SG]). For each parameter, low-and high-risk groups were defined according to cutoffs with the highest sensitivity and specificity for progression (ESRD/doubling sCr) assessed by receiver operating characteristic analysis; follow up was 60 ؎ 40 mo.Results: FEIgG/SG is the most powerful progression predictor: 5 versus 83% in all patients; in treated patients, 0 versus 89%, increased to 0 versus 100% by sCr and FEIgG/SG in combination (low risk: both markers or only one below cutoff (n ‫؍‬ 15); high risk: both markers above cutoff (n ‫؍‬ 8). The nonprogressors showed at last observation 65% proteinuria reduction and 10% sCr reduction.Conclusions: In crescentic IgA nephropathy, FEIgG/SG, which evaluates altered size selectivity in relation to nephron loss, is the best progression predictor. In treated patients, progression prediction was increased by FEIgG/SG and sCr in combination. Treatment may be restricted to low-risk patients.

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Section: Discussionsupporting

confidence: 79%

In Crescentic IgA Nephropathy, Fractional Excretion of IgG in Combination with Nephron Loss Is the Best Predictor of Progression and Responsiveness to Immunosuppression

Bazzi¹,

Rizza²,

Raimondi³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…Microalbuminuria has been described in various kidney diseases in dogs , but even though uAlb was significantly increased, the simultaneous measurement of uIgG was performed as it has been reported to allow more precise evaluation of the extent of glomerular damage (Bazzi et al, 2001). The HMW protein IgG is usually excreted when permselectivity of the glomerular capillary wall is severely disrupted (Bazzi et al, 2000(Bazzi et al, , 2001D'Amico and Bazzi, 2003). An added value of uIgG in selectivity of proteinuria was also described in dogs with different types of nephropaties (Maddens et al, , 2011Vinge et al, 2010;Smets et al, 2012;Nabity et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of snake envenomation-induced renal dysfunction in dogs using early urinary biomarkers of nephrotoxicity

Hrovat

Schoeman

Laat

et al. 2013

The Veterinary Journal

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Renal dysfunction in dogs envenomed by snakes has mostly been evaluated using routine serum and urine renal markers. Generally, these are not able to detect the renal damage at an early stage and their sensitivity is affected by hemolysis, hematuria and pigmenturia. Selective use of urinary biomarkers can provide early information on severity and stage of renal injury caused by nephrotoxic substances before major decline in renal function occurs. Therefore, the aim of this study was to evaluate venom-induced renal damage using urinary markers of glomerular (urinary albumin (uAlb), immunoglubin G (IgG) and Creactive protein (uCRP)) and proximal tubular dysfunction (urinary retinol binding protein (uRBP)) and compare these markers with routine renal markers (serum urea (BUN) and creatinine (sCr), urinary specific gravity (USG) and urinary protein to creatinine ratio (UPC)).Nineteen dogs envenomed by either neurotoxic or cytotoxic snakes and ten clinically healthy dogs were included in this study. Urinary markers were measured using previously validated commercially available ELISA kits. Among measured routine renal markers a significant difference between snake -envenomed and healthy dogs was noted only in UPC, but in the presence of hematuria and hemoglobinuria, differentiation between prerenal and renal proteinuria was not possible. The urinary biomarkers uAlb, uIgG and uRBP in snakeenvenomed dogs were significantly increased (P<0.05) when compared to healthy dogs at admission, whereas 24 h after envenomation only uCRP was significantly elevated. Using urinary /markers, results of this study showed that snake venom evokes renal dysfunction at the glomerular and tubular region of the nephron.

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“…However, the predictive value of increased urine IgG excretion was evaluated mostly in short term studies of patients with nephrotic syndrome [9][10][11]. In the present cohort, we studied the long term impact of IgG-uria in patients with glomerular diseases presenting with a wide range of proteinuria.…”

Section: Introductionmentioning

confidence: 99%

The value of IgG-uria in predicting renal failure in idiopathic glomerular diseases. A long-term follow-up study

Tofik

Aziz

Reda

et al. 2010

Scandinavian Journal of Clinical and Laboratory Investigation

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A modern approach to selectivity of proteinuria and tubulointerstitial damage in nephrotic syndrome

Cited by 118 publications

References 27 publications

In Crescentic IgA Nephropathy, Fractional Excretion of IgG in Combination with Nephron Loss Is the Best Predictor of Progression and Responsiveness to Immunosuppression

In Crescentic IgA Nephropathy, Fractional Excretion of IgG in Combination with Nephron Loss Is the Best Predictor of Progression and Responsiveness to Immunosuppression

Evaluation of snake envenomation-induced renal dysfunction in dogs using early urinary biomarkers of nephrotoxicity

The value of IgG-uria in predicting renal failure in idiopathic glomerular diseases. A long-term follow-up study

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