Clinical Chemistry and Laboratory Medicine (CCLM)
Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)
Editor-in-Chief: Plebani, Mario
Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter
IMPACT FACTOR 2017: 3.556
CiteScore 2018: 2.44
SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205
Urinary α1-Microglobulin Detects Uropathy. A Prospective Study in 483 Urological Patients
Purpose: The aim of the study was to evaluate prospectively urinary α1-microglobulin as a marker of proximal tubular damage following acute pyelonephritis and outflow disease of the upper urinary tract in a urological population with minimal exclusion criteria. We also measured the urinary γ-glutamyltransferase activity, urinary albumin, urinary and serum creatinine, serum IgA and serum α1-microglobulin.
Patients and methods: We studied 483 urological patients (age: 1 to 92 years, 297 men, 186 women) excluding patients receiving nephrotoxic drugs, or suffering from type 1 diabetes or renal diseases. There were 141 patients with urinary tract infection but no fever, 36 patients with high fever of non-renal origin, 51 patients with acute pyelonephritis and 156 patients with outflow disease of the upper tract, and 99 patients were incluced in the reference population.
Results: For acute pyelonephritis, vesico-ureteral reflux, and ureteral obstruction, urinary α1-microglobulin had a sensitivity of 94%, 90% and 63% respectively and a specificity of 67%, 77% and 76%. The area under the curve of the receiver operator characteristic curve was significantly (p < 0.001) higher for urinary α1-microglobulin than for albumin or γ-glutamyltransferase activity. Unexpected positive results were found in acute prostatitis. The urinary α1-microglobulin was the only parameter which differentiated between acute prostatitis and pyelonephritis (p < 0.001). Creatinine clearance or age had little and gender had no influence on the urinary excretion of α1-microglobulin. Urine production rate significantly increases the urinary α1-microglobulin/creatinine ratio.
Conclusion: Our results suggest that the urinary α1-microglobulin/creatinine ratio is a diagnostically useful marker of tubular damage in acute pyelonephritis and vesico-ureteral reflux in the urological population. Following renal colic and chronic ureteral obstruction, a significant increase in urinary α1-microglobulin excretion was observed.
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