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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Clin+J+Am+Soc+Nephrol
2016 ; 11
(4
): 593-601
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gab.com Text
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English Wikipedia
Prognostic Value of Tubulointerstitial Lesions, Urinary
N-Acetyl-?-d-Glucosaminidase, and Urinary ?2-Microglobulin in Patients with Type
2 Diabetes and Biopsy-Proven Diabetic Nephropathy
#MMPMID26801478
Mise K
; Hoshino J
; Ueno T
; Hazue R
; Hasegawa J
; Sekine A
; Sumida K
; Hiramatsu R
; Hasegawa E
; Yamanouchi M
; Hayami N
; Suwabe T
; Sawa N
; Fujii T
; Hara S
; Ohashi K
; Takaichi K
; Ubara Y
Clin J Am Soc Nephrol
2016[Apr]; 11
(4
): 593-601
PMID26801478
show ga
BACKGROUND AND OBJECTIVES: Some biomarkers of renal tubular injury are reported
to be useful for predicting renal prognosis in the early stage of diabetic
nephropathy (DN). Our study compared predictions of the renal prognosis by such
biomarkers and by histologic tubulointerstitial damage. DESIGN, SETTING,
PARTICIPANTS, & MEASUREMENTS: Among 210 patients with type 2 diabetes and
biopsy-proven DN managed from 1985 to 2011, 149 patients with urinary
N-acetyl-?-d-glucosaminidase (NAG) and urinary ?2-microglobulin (?2-MG) data at
the time of renal biopsy were enrolled. The primary outcome was a decline in eGFR
of ?50% from baseline or commencement of dialysis for ESRD. RESULTS: The median
follow-up period was 2.3 years (interquartile range, 1.1-5.3), and the primary
outcome was noted in 94 patients. Mean eGFR was 46.3±23.2 ml/min per 1.73 m(2),
and 132 patients (89%) had overt proteinuria at baseline. Cox proportional
hazards analysis revealed that the association of urinary NAG and ?2-MG with the
outcome was attenuated after adjustment for known promoters of progression (+1 SD
for log NAG: hazard ratio [HR], 1.14; 95% confidence interval [95% CI], 0.84 to
1.55; +1 SD for log ?2-MG: HR, 1.23; 95% CI, 0.94 to 1.62). In contrast, the
interstitial fibrosis and tubular atrophy (IFTA) score was still significantly
correlated with the outcome after adjustment for the same covariates (+1 for IFTA
score: HR, 2.31; 95% CI, 1.56 to 3.43). Moreover, adding the IFTA score to a
model containing known progression indicators improved prediction of the outcome
(increase of concordance index by 0.02; 95% CI, 0.00 to 0.05; category-free net
reclassification improvement by 0.54; 95% CI, 0.03 to 1.05; and relative
integrated discrimination improvement by 0.07; 95% CI, -0.08 to 0.22).
CONCLUSIONS: Adding urinary NAG and ?2-MG excretion to known promoters of
progression did not improve prognostication, whereas adding the IFTA score did.
The IFTA score may be superior to these tubulointerstitial markers for predicting
the renal prognosis in advanced DN.
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