Abstract Objective To study the value of the determination of serum and urine haptoglobin (HP) and alpha 1-antitrypsin (AAT) in predicting the response to glucocorticoid therapy in children with primary nephrotic syndrome (PNS). Methods A total of 84 children with PNS were classified to steroid-sensitive nephrotic syndrome (SSNS) (n=58) and steroid-resistant nephrotic syndrome (SRNS) groups (n=26). Forty healthy children were randomly selected for the control group. HP and AAT levels in blood and urinary samples were determined using ELISA. The efficiency of HP and AAT in predicting the response to glucocorticoid treatment of PNS was evaluated by the receiver operating characteristic (ROC) curve. Results Compared with the control group, both the SSNS and SRNS groups had significantly higher serum HP concentrations and urine AAT/Cr ratio before treatment (P<0.05); compared with the SSNS group, the SRNS group had significantly higher serum HP concentrations and urine AAT/Cr ratio before treatment and after one week and four weeks of treatment (P<0.05). Serum HP had the highest efficiency in predicting the response to glucocorticoid treatment of PNS at the concentration of 37.935 mg/mL, with the sensitivity and specificity being 92.3% and 86.2% respectively. Urine AAT/Cr ratio had the highest prediction efficiency at 0.0696, with the sensitivity and specificity being 100% and 79.3% respectively. ROC curve analysis of serum HP combined with urine AAT/Cr ratio showed a better prediction efficiency, with the sensitivity and specificity being 92.3% and 96.6% respectively. Conclusions The increase in serum HP level or urine AAT/Cr ratio may indicate glucocorticoid resistance in the early stage of PNS. A combination of the two can achieve better efficiency in the prediction of SRNS.
About author:: 10.7499/j.issn.1008-8830.2015.03.005
Cite this article:
YANG Juan,ZHANG Bi-Li. Value of determination of haptoglobin and α1-antitrypsin in predicting response to glucocorticoid therapy in children with primary nephrotic syndrome[J]. CJCP, 2015, 17(3): 227-231.
YANG Juan,ZHANG Bi-Li. Value of determination of haptoglobin and α1-antitrypsin in predicting response to glucocorticoid therapy in children with primary nephrotic syndrome[J]. CJCP, 2015, 17(3): 227-231.
Strandhave C, Krarup H, Christensen JH, et al. Haptoglobin genotype and risk markers of cardiovascular disease in patients with chronic kidney disease[J]. Int J Nephrol, 2013, 2013: 650847.
Wen Q, Huang LT, Luo N, et al. Proteomic profiling identifies haptoglobin as a potential serum biomarker for steroid-resistant nephrotic syndrome[J]. Am J Nephrol, 2012, 36(2): 105-113.
[10]
Bhensdadia NM, Hunt KJ, Lopes-Virella MF, et al. Urine haptoglobin levels predict early renal functional decline in patients with type 2 diabetes[J]. Kidney Int, 2013, 83(6): 1136-1143.
[11]
Magistroni R, Ligabue G, Lupo V, et al. Proteomic analysis of urine from proteinuric patients shows a proteolitic activity directed against albumin[J]. Nephrol Dial Transplant, 2009, 24(5): 1672-1681.
[12]
Hidvegi T, Schmidt BZ, Hale P, et al. Accumulation of mutant alpha1-antitrypsin Z in the endoplasmic reticulum activates caspases-4 and -12, NF kappaB, and BAP31 but not the unfolded protein response[J]. J Biol Chem, 2005, 280(47): 39002-39015.
[13]
Candiano G, Musante L, Petretto A, et al. Proteomics of plasma and urine in primary nephrotic syndrome in children[J]. Contrib Nephrol, 2008, 160: 17-28.
[14]
Graterol F, Navarro-Muñoz M, Ibernon M, et al. Poor histological lesions in IgA nephropathy may be reflected in blood and urine peptide profiling[J]. BMC Nephrol, 2013, 14(1): 82.
[15]
Carlson JA, Rogers BB, Sifers RN, et al. Multiple tissues express alpha 1-antitrypsin in transgenic mice and man[J]. J Clin Inves, 1988, 82(1): 26.
[16]
Liew CT. Alpha-1-antitrypsin in the renal tubular epithelium in patientswith orwithoutalpha-1-antitrypsin deficiency[J]. Changgeng Yi Xue Za Zhi, 1990, 13(1): 1-9.
