Assessment of renal function: selected developments

doi:10.1016/0009-9120(90)90435-W

Clinical Biochemistry

Volume 23, Issue 1, February 1990, Pages 49-54

https://doi.org/10.1016/0009-9120(90)90435-W Get rights and content

Tests commonly used to assess the glomerular filtration rate (GFR) and to detect renal tubular damage are critically reviewed. Creatinine clearance which is frequently used for assessment of the GFR is prone to several errors. The plasma creatinine can be used to provide a rough guide but for reliable measurement of the GFR, ⁵¹Cr-EDTA clearance is recommended. Measurements of the urinary excretion of low molecular weight proteins, enzymes and kidney tissue proteins have been used to detect tubular damage. Of the low molecular weight proteins excreted, beta-2-microglobulin is unstable and measurement of retinol-binding protein or alpha-1-microglobulin is recommended for the detection of chronic renal tubular malfunction. Of the many enzymes that have been studied, urinary N-acetyl-beta-D-glucosaminidase or alanine aminopeptidase are recommended as being the most useful for the early detection of acute renal tubular damage. Among renal tissue proteins that have been measured in urine adenosine-deaminase-binding protein, a tubular brush border antigen appears to have considerable potential for providing early warning of renal allograph rejection.

References (39)

JacobsenFK et al.
Evaluation of kidney function after meals
Lancet
(1980)
ShemeshO et al.
Limitations of creatinine as a filtration marker in glomerulopathic patients
Kidney Int
(1985)
WalserM et al.
Creatinine measurements often yield false estimates of progression in chronic renal failure
Kidney Int
(1988)
SchardijnGHC et al.
Beta-2-microglobulin: its significance in the evaluation of renal function
Kidney Int
(1987)
NordenAGW et al.
Degradation of beta-2-microglobulin in infected urine by leukocyte elastase-like activity
Clin Chim Acta
(1983)
PriceRG
Urinary enzymes, nephrotoxicity and renal disease
Toxicology
(1982)
BackmanL et al.
Glutathione transferase in the urine: a marker for post-transplant tubular lesions
Kidney Int
(1988)
KotankoP et al.
Urinary enzyme analysis in renal allograft transplantation
Clin Chim Acta
(1986)
ZagerRA et al.
Radioimmunoassay for urinary renal tubular antigen: a potential marker of tubular injury
Kidney Int
(1978)
MuttiA et al.
Urinary excretion of brush-border antigen revealed by monoclonal antibody: early indicator of toxic nephropathy
Lancet
(1985)

FalkenbergFW et al.

Kidney-derived urinary antigens assayed with monoclonal antibodies for the detection of renal damage

Clin Chim Acta

(1986)

de WardenerHE

The kidney

(1985)

AndersonCF et al.

Renal handling of creatinine in nephrotic and non-nephrotic patients

Clin Sci

(1970)

StatlandBE et al.

Factors contributing to intra-individual variation of serum constituents: 2. Effects of exercise and diet on variation of serum constituents in healthy subjects

Clin Chem

(1973)

RosanoTG et al.

Analytical and biological variability of serum creatinine and creatinine clearance: implications for clinical interpretation

Clin Chem

(1982)

SpencerK

Analytical reviews in clinical biochemistry: the estimation of creatinine

Ann Clin Biochem

(1986)

MitchWE et al.

Creatinine metabolism in chronic renal failure

Clin Sci

(1980)

Brochner-MortensenJ et al.

Selection of routine method for determination of glomerular filtration rate in adult patients

Scand J Clin Lab Invest

(1976)

PayneRB

Creatinine clearance: a redundant clinical investigation

Ann Clin Biochem

(1986)

Cited by (57)

Elevated urinary β2 microglobulin in the first identified Japanese family afflicted by X-linked myopathy with excessive autophagy
2013, Neuromuscular Disorders
Citation Excerpt :
Increased urinary β2 MG is indicative either of increased serum β2 MG or dysfunction of the proximal convoluted tubules. Serum β2 MG is increased in patients with malignant tumors, autoimmune disease, infection (including with hepatitis B virus, infectious mononucleosis, and human immunodeficiency virus), or glomerular dysfunction [10,11]. All current affected family members were free from malignant tumors, autoimmune disease, and infection, so in these cases, the increased urinary β2 MG may have been attributed to dysfunction of the proximal convoluted tubules; however, other markers of renal function suggested that this was unlikely.
Here we report what is to our knowledge the first identified Japanese family afflicted by X-linked myopathy with excessive autophagy. The index case is a 52-year-old man with almost 40 years of progressive proximal muscle weakness. High urinary β2 microglobulin, normal serum β2 microglobulin, autophagic vacuoles with sarcolemmal features, and a hemizygous c.164–7T>G mutation in the VMA21 gene were found. His two maternal uncles had similar clinicopathological findings. High urinary β2 microglobulin without obvious renal dysfunction might result from decreased urine acidification in the distal convoluted tubules caused by the VMA21 gene mutation. These findings might prove to be useful as a preliminary marker suggestive of X-linked myopathy with excessive autophagy.
Diabetic nephropathy: Traditional to proteomic markers
2013, Clinica Chimica Acta
Citation Excerpt :
Biomarkers of tubular lesions are essentially urinary enzymes (enzymuria) and plasma proteins of low molecular weight. Their increased excretion in the urine originates from the deficient reabsorption of plasma proteins by the tubular cells, or increased secretion of urine enzymes by tubular epithelial cells, both of which lead to proteinuria [48,57,58]. The urinary excretion of enzymes increases due to its release from cells that are damaged or regenerating [59].
Diabetic nephropathy (DN) is one of the major microvascular complications of diabetes and it is defined as a rise in the urinary albumin excretion (UAE) rate and abnormal renal function. Currently, changes in albuminuria are considered a hallmark of onset or progression of DN. However, some patients with diabetes have advanced renal pathological changes and progressive kidney function decline even if urinary albumin levels are in the normal range, indicating that albuminuria is not the perfect marker for the early detection of DN. The present article provides an overview of the literature reporting some relevant biomarkers that have been found to be associated with DN and that potentially may be used to predict the onset and/or monitor the progression of nephropathy. In particular, biomarkers of renal damage, inflammation, and oxidative stress may be useful tools for detection at an early stage or prediction of DN. Proteomic-based biomarker discovery represents a novel strategy to improve diagnosis, prognosis and treatment of DN; however, proteomics-based approaches are not yet available in most of the clinical chemistry laboratories. The use of a panel with a combination of biomarkers instead of urinary albumin alone seems to be an interesting approach for early detection of DN, including markers of glomerular damage (e.g., albumin), tubular damage (e.g., NAG and KIM-1), inflammation (e.g., TNF-α) and oxidative stress (e.g., 8-OHdG) because these mechanisms contribute to the development and outcomes of this disease.
Identification of Renal Injury in Cardiac Surgery: The Role of Kidney-Specific Proteins
2008, Journal of Cardiothoracic and Vascular Anesthesia
Citation Excerpt :
Because this membrane is affected first by renal insults, NEP measured in the urine it is suggested to be an early and sensitive marker of tubular damage (Table 4).51 Retinol-binding protein (RBP) is freely filtered by the glomerulus and almost completely reabsorbed (99.9%) by the proximal tubule.51,52 As such, urinary excretion of RBP is an indicator of tubular dysfunction.51,52
The comparison of cystatin C and creatinine as an accurate serum marker in the prediction of type 2 diabetic nephropathy
2007, Diabetes Research and Clinical Practice
In a clinic-based, cross-sectional study of 320 type 2 diabetic patients, we staged the level of diabetic nephropathy (normoalbuminuric, microalbuminuric and macroalbuminuric stage) and estimated GFR based on serum creatinine and cystatin C (CysC). Serum creatinine and CysC levels were 0.91 ± 0.21 mg/dL and 0.87 ± 0.26 mg/L, respectively. Correlation coefficients between CysC-GFR and each of the creatinine-based GFR measurements (MDRD-GFR, Cockcroft-Gault-GFR, and CLcr) were 0.589, 0.569, and 0.479 (p < 0.001). Serum CysC was significantly lower in normoalbuminurics (0.83 ± 0.22) than in microalbuminurics and macroalbuminurics (0.94 ± 0.33 and 1.05 ± 0.28; p = 0.004 and p < 0.001). Of the estimations of GFR, significant differences among the groups were found on CysC-GFR and CLcr. CysC-GFR (mL/min) was statistically lower in macroalbuminurics (79.5 ± 30.5) than in normoalbuminurics (104.3 ± 30.9, p = 0.01). The logistic regression analyses showed that retinopathy, A1C, CysC, diabetic duration, and CysC-GFR were indicators to predict the development of microalbuminuria.
Serum CysC seems to be more accurate serum marker than serum creatinine in evaluating a prognostic stage of type 2 diabetic nephropathy. Our study suggests that, in Korean type 2 diabetic patients, CysC-based GFR might be more valuable than creatinine-based GFR in the prediction of the microalbuminuric stage.
Oxidative damage in the kidney induced by 900-MHz-emitted mobile phone: Protection by melatonin
2005, Archives of Medical Research
Citation Excerpt :
NAG is also found in serum but its molecular weight of 140 kDa does not permit glomerular filtration; thus, increased urinary NAG activity is one of the most sensitive markers of renal tubular damage (15,31–33). It appears in the urine after damage of the cell membranes of the proximal tubules and predominantly reflects tubulointerstitial injury and toxicity including those caused by drug toxicity (31,34). To investigate the possibility of subtle renal impairment, we measured urinary NAG activity in EMR-exposed rats.
The mobile phones emitting 900-MHz electromagnetic radiation (EMR) may be mainly absorbed by kidneys because they are often carried in belts. Melatonin, the chief secretory product of the pineal gland, was recently found to be a potent free radical scavenger and antioxidant. The aim of this study was to examine 900-MHz mobile phone-induced oxidative stress that promotes production of reactive oxygen species (ROS) on renal tubular damage and the role of melatonin on kidney tissue against possible oxidative damage in rats.
The animals were randomly grouped as follows: 1) sham-operated control group and 2) study groups: i) 900-MHz EMR exposed (30 min/day for 10 days) group and ii) 900-MHz EMR exposed + melatonin (100 μg kg⁻¹ s.c. before the daily EMR exposure) treated group. Malondialdehyde (MDA), an index of lipid peroxidation), and urine N-acetyl-β-d-glucosaminidase (NAG), a marker of renal tubular damage were used as markers of oxidative stress-induced renal impairment. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities were studied to evaluate the changes of antioxidant status.
In the EMR-exposed group, while tissue MDA and urine NAG levels increased, SOD, CAT, and GSH-Px activities were reduced. Melatonin treatment reversed these effects as well. In this study, the increase in MDA levels of renal tissue and in urine NAG and also the decrease in renal SOD, CAT, GSH-Px activities demonstrated the role of oxidative mechanism induced by 900-MHz mobile phone exposure, and melatonin, via its free radical scavenging and antioxidant properties, ameliorated oxidative tissue injury in rat kidney.
These results show that melatonin may exhibit a protective effect on mobile phone-induced renal impairment in rats.
Biochemical and histopathological examination of the effect of cigarette smoking on rat kidneys
2017, Analytical and Quantitative Cytopathology and Histopathology

View all citing articles on Scopus

View full text

Assessment of renal function: selected developments

Lancet

Kidney Int

Kidney Int

Kidney Int

Clin Chim Acta

Toxicology

Kidney Int

Clin Chim Acta

Kidney Int

Lancet

Clin Chim Acta

The kidney

Renal handling of creatinine in nephrotic and non-nephrotic patients

Clin Sci

Factors contributing to intra-individual variation of serum constituents: 2. Effects of exercise and diet on variation of serum constituents in healthy subjects

Clin Chem

Analytical and biological variability of serum creatinine and creatinine clearance: implications for clinical interpretation

Clin Chem

Analytical reviews in clinical biochemistry: the estimation of creatinine

Ann Clin Biochem

Creatinine metabolism in chronic renal failure

Clin Sci

Selection of routine method for determination of glomerular filtration rate in adult patients

Scand J Clin Lab Invest

Creatinine clearance: a redundant clinical investigation

Ann Clin Biochem