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2009 ; 403
(1-2
): 42-46
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Proteinuria without albuminuria: urinary protein excretion by a subset of
patients with burn injuries
#MMPMID19361474
Sviridov D
; Owen WE
; Roberts WL
; Edelman LS
; Drake SK
; Hortin GL
Clin Chim Acta
2009[May]; 403
(1-2
): 42-46
PMID19361474
show ga
BACKGROUND: There is disagreement regarding the utility of urinary albumin
excretion as a marker for capillary injury in patients with severe burn injuries.
We examined protein components in urine specimens from patients with burn injury.
METHODS: Detailed analysis was performed for a set of 5 urine specimens selected
based on a high ratio of albumin-sized molecules by size-exclusion HPLC (Accumin)
versus albumin by immunoassay methods. Specimens were analyzed for total protein,
alpha(1)-microglobulin, alpha(1)-acid glycoprotein, cystatin C, and
retinol-binding protein. Urine components were analyzed by chromatographic and
electrophoretic methods. Major components were identified by mass spectrometry of
tryptic peptides. RESULTS: A subset of urine specimens had increased total
protein with slight increases in albumin by immunoassay or by polyacrylamide gel
electrophoresis. Albumin values by size-exclusion HPLC were more than 10-fold
higher. Immunoassays for alpha(1)-microglobulin and alpha(1)-acid glycoprotein
yielded concentrations 5-10 fold higher than for albumin. Other major components
identified included zinc-alpha(2)-glycoprotein and
leucine-rich-alpha(2)-glycoprotein. CONCLUSIONS: A subset of patients with burn
injury had increased total urinary protein resulting primarily from increased
excretion of proteins such as alpha(1)-microglobulin and alpha(1)-acid
glycoprotein with little increase in albumin excretion. The unusual composition
of urinary proteins in these patients may relate to decreased filtered load of
albumin and increased filtered load of acute phase reactants or to alterations in
renal tubular protein processing. Thus, measurement of urinary albumin may have
decreased sensitivity for detecting kidney injury in burn patients.