| Objective:Primary nephrotic syndrome(PNS) is the common renal disease,acute renal failure(ARF)is one of the common and serious complications.Acute tubular necrosis(ATN) is the primary pathological feature in the patients of PNS complicated with ARF,and ATN was significantly upregulated prior to the increase in serum creatinine in some patients of PNS complicated with ARF.Renal biopsy puncture is the clinical gold standard to diagnose the ATN,but it is of destructiveness,chanciness and limitations.So trying to find more convenient,specific and sensitive biologic factors to help the diagnosis of PNS complicated with ATN is essential and of significant clinical value.According to the studies,many urine molecules related to acute kidney injure(AKI) were found,Interleukin-18(IL-18) and kidney injury molecule-1(KIM-1) were two of the important cytokines .Our study is to investigate the urinary level of IL-18 and KIM-1(by enzyme linked immunosorbent assay) in the patients of PNS, and to carry out the relative researches with trial index commonly used in clinical index (such as 24h urine protein,serum creatinine,tubulointerstitial lesions),so as to discuss the possible effect of IL-18 and KIM-1 in the PNS complicated with ARF.Methods: Step1:We selected 74 patients as the cases(44 men, 30 women), who conformed to the criterion of primary nephrotic syndrome(24h urine protein>3.5g, plasma albumin<30g/L).They were divided into four groups:1.Minimal change disease (MCD)(18 men and 15 women); 2.Membranous nephropathy (MN)(15 men and 12 women, 18 Stage I MN cases, 7 Stage II MN,2 StageⅢMN);3.Focal segmental glomerulosclerosis (FSGS)(4 men and 2 women,4 non-special-type fsgs cases, 2 top-type fsgs cases),4.mesangial proliferative glomerulonephritis(MsPGN)group(5 men and 3 women).MCD group were divided into two groups(complicated with ATN group and no complicated with ATN group).Step2:15 cases (8 men and 7 women) were collected from the patients who were performed normal urine analysis in the health examination.Step3:Enzyme linked immunosorbent assay(ELISA)was applied to detect the urinary level of IL-18 and KIM-1in PNS patients and the control group.Also comparations were made between those four groups and the control group.Step4:Determine the clinical index(such asβ2MG,24h urine protein,serum creatinine),correlation analysis was processed between immunohistochemical result and clinical index.Step5:Differences among groups were evaluated by one-way analysis of variance test.To determine the significance between group means in the analysis of variance,the nearest significant difference test (SNK-q test) was used as the multiple comparison test.Step6:SPSS 10.0 statistical software is used to analyze the above mentioned data, in which process the significance was set at p<0.05.Results:1.Compared with normal controls,the urinary level of IL-18 were significantly increased in patients with PNS,but there were no significant difference among the four different pathology types of renal biopsy.The urinary level of IL-18 in MCD complicated with ATN group were significantly increased than the MCD without ATN group.The urinary level of IL-18 in the control group,MCD group,MN group,FSGS group,MsPGN group was(21.02±15.62,59.30±18.93,53.97±13.94,61.23±22.12,58.27±12.48)pg/ml.2.To the urinary level of KIM-1,there were no difference between the patients of PNS and normal controls,moreover there were no difference among the four different pathology types of renal biopsy.But the urinary level of KIM-1 in the MCD complicated with ATN group were significantly increased than the MCD without ATN group.The urinary level of KIM-1 in the control group,MCD group,MN group,FSGS group, MsPGN group was(6.01±0.59,6.17±1.70,5.98±1.06,6.16±2.27,6.13±1.58)ng/ml.3.The urinary level of IL-18 were positively correlated with 24h urine protein quantitation, urineβ2MG,serum creatinine,serum urea nitrogen and the tubulointerstitial lesions,were negatively correlated with urine osmotic pressure.The urinary level of KIM-1 were positively correlated with urineβ2MG,serum creatinine,serum urea nitrogen and the tubulointerstitial lesions,were negatively correlated with urine osmotic pressure.No relationship was found between their levels and plasma albumin.4.The urinary level of IL-18 were highly correlated with the level of urine KIM-1.Conclusion:1.The urinary level of IL-18 were significantly increased in patients of PNS,especially in patients of PNS complicated with ATN.Urinary IL-18 not only may predict ATN,but also,to a certain extent,may reflect the injure of glomerulus.2.The urinary level of KIM-1 were significantly increased in patients of PNS complicated with ATN.Urinary KIM-1 may predict ATN,but probably it was unable predict the injure of glomerulus.3.The urinary level of IL-18 and KIM-1 increased prior to the clinical biological parameter(such as serum creatinine,urine osmotic pressure) in AKI patients.IL-18 and KIM-1 were specific and sensitive biologic factors in the diagnosis of AKI.4.The urinary level of IL-18 were highly correlated with the KIM-1 . |
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