| Prediction of Steroid Responsiveness in the Primary Nephrotic Syndrome Using Urinary β2-Microglobulin Level and N-Acetyl-β-D-Glucosaminidase Activity |
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Kwang In Lee, In Seok Lim, Eung Sang Choi |
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Department of Pediatrics, College of Medicine, Chung-Ang University, Seoul, Korea |
| 신증후군 환아의 요중 β2-Microglobulin치와 N-acetyl-β-D-Glucosaminidase 활성도를 이용한 스테로이드 치료 반응의 예측 |
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이광인, 임인석, 최응상 |
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중앙대학교 의과대학 소아과학교실 |
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| Abstract |
Purpose
: Considering that renal biopsy is not routinely indicated in nephrotic syndrome in
children and the risk of the procedure, we studied that it is possible to predict steroid
responsiveness in nephrotic syndrome and the difference in responsivenss is related with the
histopathologic type using urinary β2-microglobulin and N-Acetyl-β-D-Glucosaminidase
activity as a safe and noninvasive method.
Methods
: We measured serum creatinine, albumin, cholesterol and urinary creatinine,
protein, B2M, NAG at the time of admission and after 2 weeks of treatment in 37 cases
of primary nephrotic syndrome in children who were admitted to the Pediatric
department of Chung-Ang Medical Center between March 1, 1994 and June 30, 1996.
Results
: The results were as follows :
1) When urinary B2M value of less than 1000μg/g creatinine was used as the cut-off
value, the test identified steroid responsiveness with a sensitivity of 100%, a specificity
of 80%. When urinary NAG activity of less than 100U/hr/mg creatinine was used as the
cut-off value, the test identified steroid responsiveness with a sensitivity of 100%, a
specificity of 81.8%.
2) Pretreatment urinary B2M levels in Good-response and Poor-response group were
559.8±718.5μg/g creatinine, 3599.1±4956.7μg/g creatinine, respectively. There was statistical
significance between the two groups(P < 0.05).
3) Pretreatment urinary NAG activity in Good-response and Poor-response group
were 42.6±23.6U/hr/mg creatinine, 79.6±80.1U/hr/mg creatinine, respectively. There was
statistical significance between the two groups(P < 0.05).
Conclusions
: In conclusion, measurement of urinary B2M level and NAG activity for
early detection of renal tubular damage is helpful in prediction of steroid responsiveness
of primary nephrotic syndrome. If the urinary B2M level and NAG activity are elevated,
the patient is suspected to steroid resistance. Therefore, prolonged steroid therapy should
be avoided in such patients because of their greater chance of not responding. This
approach would reduce the many serious side effects of prolonged treatment in patients
who are unlikely to benefit. |
| Key Words:
Nephrotic syndrome, β2-Microglobulin(B2M), N-acetyl-β-D-Glucosaminidase(NAG) |
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